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DIBS 17 3'35 APPLICATION FOR ■ LIJ.i. BING PERMIT
7
DBS 17 1
DIVISION OF BUILDING AND SAFETY
Department of County Engineer
County of Los Angeles BUILDING /l
WM J FOX COUNTY ENGINEER ADDRESS '� &,V�
CASSATT D GRIFFIN SUP T OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST+
OWNER DISTRICT NO .G-RSO+U I�(E REAOY FOR INSPECTION
MAIL
ADDRESS O .Jy
INDUSTRIAL
CIT TEL NO Iff WASTE APPROVAL
PLUMBERlsvu/ INSPECTION RECORD
ADDRESS -vR ...e
CITY TEL NO 1 J G ,cn.
LICENSE NO
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) $
BATH TUB
SHOWER
LAVATORY (WASH BASIN) -
KITCHEN SINK
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER
TOTAL NO apo a0 3 APPROVALS
DATE OSPECTOR S SIGNATURE
GAS SYSTEM OUTLETS @ 1 00 "� �
WATER HEATER na 1 00 ,+� UNDER SLAB WORK
PERMIT 1 00
ROUGH PLUMBING 1 Co �S
� $
GAS PIPING �� ..L534". 7 y
TOTAL FEE 4� Q GAS VENT
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABODE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES 11 SG• «.s
PLUMBING IW
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO NOTIFIED ~
CALIFORNIA OP THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESI DEPTIJAe7RO PERTY
SIGNATURE 4
OF PERMITTEElir FINAL K
WILLIAM J FOX COUNTY ENGINEER VALIDATION R A WOOD CHIEF PLBG INSPECTOR
� a82OS JUN 17 3 6.20 0