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7BS-17 APPLICATION FOR 0 LU�da �ONG PERMIT
DBS-17
BUILDING AND SAFETY
bepo=tment of County Engineer
County of Los Angeles BUILDING L1
JOHN A. LAMBIE, COUNTY ENGINEER, ADDRESS % 3�
CASSATT D. GRIFFIN,SUPT OF BUILDING
- r.,._. LOCALITY
FOR APPLICANT TO FILL IN I NEAREST /
CROSS ST.
OWNER - DISTRICT NO. GROUP ZONE READY FOR INSPECTION
# MAIL
ADDRESS c-•.
INDUSTRIAL
CITY TEL. NO. WASTE APPROVAL -
PLUMBER ^, tai/' J INSPECTION RECORD, -
ADDRESS /v 'trl� OA�G$: I -�.�. AXG vtsP f P /,x''4.O
� � gyp-- _ _
CITY TEL. NO. ./ A2`1 " ^-" 'fid
LICENSE NO. L � 3 4-K ' S1�1 A �"' y!
NUMBER TYPE OF FIXTURE OR ITEM FEEu ..�A
WATER CLOSET (TOILET) - @ $1.00 $ '
® BATH TUB @ $1.00
SHOWER @ $1.00 JvV
LAVATORY (WASH BASIN) @ $1.00 !�
KITCHEN SINK @ $1.00
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER @ $1.b0 lip
S
WATER HEATER @ $1.00 -
GAS SYSTEM @ $1.00 gl -
APPROVALS
DATE - INSPECTOR'S SIGNATURE
UNDER'SLAB WORK ., n
PERMIT t 00 ROUGH PLUMBING /
$
GAS PIPING
TOTAL FEE GAS VENT*
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS -APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVEAS CORRECT AND AGREE TO COMPLY -- n
'• WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES '1
,(
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST 1� yu� r• -J'.[__ v-, _
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF v
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED d
.: DESCRIBED RESIDENTIALP E Y.
SIGNATURE /
OF PERM 11 1 Lr-72KFINAL
JOHN A. LAMBIE. COUNTY INGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CR. M.-0. .CASH
L, 9 8,4 3 ZR SEP �}' 3 �;�r.0 0 {m