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nes.IT APPLICATION FOR PLUMBING PERMIT 1
(DIVISION.OF BUILDING AND SAFETY
Deportment of County Engineer
County of Los Angeles BUILDI�_ S JOHN A. LAMBIE. COUNTY ENGINEER ADDRESCASSATT D. GRIFFIN,SUPT OF BUILDINGLOCALI
FOR APPLICANT TO FILL IN NEAREST
/� CROSS ST.
OWNER �/' DISTRICT NO. GROUP ZONE READY 10. InSPEcr ion
MAIL
ADDRESS JC b
INDUSTRIAL I
CITY TEL. NO.. WASTE APPROVAL f
PLUMBER11
1 INSPECTION RECORD
ADDRESC/
CIT � zgqL. Nljj tt X74
3LICENSE NO. f lOJ/�p�sWFE37 C_ 3 V
NUMBERI TYPE OF FIXTURE OR ITEM FEE
WATERCLOSET (TOILET) @ $1.00 $ 60
BATH TUB @ $1.00 b
SHOWER @ $1.00 0
LAVATORY (WASH BASIN) @ $1.00 0q�0
/ KITCHEN SINK @ $1.00 JL
DISHWASHER @ $1.00
LAU NDRY TU B OR TRAY @ $1.00 nn
CLOTHES WASHER @ S1.00 K/
WATER HEATER @ $1.00 c'0
GAS SYSTEM @ $1.00
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK II ^
PERMIT $ l 7 00 ROUGH PLUMBING .i 4.'�'"L • -Pd` ver
GASPIPING
TOTAL FEE VIJ GAS-VENT
1 HEREBY ACKNOWLEDGE THAT I HAVE READ.TH IS APPLICATION. HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
1 HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR GAS TEST "y— IC —^ +/
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF M x
CALIFORNIA OR THAT i AM THE LEGAL OWNER OF THE ABOVE. UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIAL PytPERTY.
SIGNATURE ' `
OFPERMITTEE FINAL
JOHN A. LAMBIEUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. e.Y, GASH
l jG 4.3 0 4—� MAR 2.0 3 1 1 .0 0 In