HomeMy Public PortalAbout9628 1/4 BROADWAY_Plumbing__ Do...,s� APPLICATION FOR PLUMBING PERMIT 1
oeB.IT DIVISION OF BUILDING AND SAFETY
Deportment of County Engineer
County of Los Angeles BUILDING !f a Tf
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS R'"
CASSATT D. GRIFFIN,SUPT OF BWLUIrvc
LOCALITY
FOR APPLICANT TO FILL IN I NNEARE__ CROSSsT. L
OWNER /'7$ // L'P h S n e! DISTRICT NO, GROUP ZONE SFAOY Foe INIIECT106
MAILI `
ADDRESS ,�j,••
•-� /� INDUSTRIAL
CITY / &_' Cs V TEL. NO. WASTE APPROVAL
PLUMBER ,.S' - C v a jiv INSPECTION RECORD
ADDRESS / I r� 1 W G'{' r+ �` J' Iti�1 �,�1`.�\)IC C L_tl.'•'I'4"r:v
CITY /L+ n TEL. NOL7I '6 V'� r+10P + L,\ '•M:.L(
LICENSE NO, j 00
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 $ i
BATH TUB @ $1.00
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1.00
KITCHEN SINK @ $1.00
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER @ S1.00
j WATER HEATER @ $1.00
GAS SYSTEM @ $1.00
APPROVALS
DATE INSPECTOR S SIGNATURE
UNDER SLAB WORK P `t k 1
PERMIT $ 1 00 ROUGHPLUMBING �IS—c _P` i l AFI(• -
GAS PIPING t( \7
TOTAL FEE GAS VENT r
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION I\
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER a
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST w �'
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THEGA OWNER OF THE ABOVE UTILITY CO. NOTIFIED V V
DESCRIBED RESIDENTIAL PRQ
.4 ►ERT�
SIGNATURE
OF PERMITTEE FINAL � k
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
97, Id.0. CASH
j,C0 4 4 4 5 Jua 2 4 3 t3.(� U ID
`_�AI�