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- APPLICATION FOR PLUMBING PERMIT
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DIVISION OF BUILDING AND SAFETY $;
'. Department of County Engineer
County of Los Angeles BUILDING /'' I�
WM. J. FOX. COUNTY ENGINEER ADDRESS LJ 777,2777=777
CASSATT D. GRIFFIN. SUPT OF BUILDING
LOCALITY 7A�w
FOR APPLICANT TO FILL IN -NEAREST
ROSS ST.
OWNER -bt 4, DISTRI,{CT/NO_ G•R�OUP Z�O/�N�/E Renov FOR InsPEcry on
ADDRESS a ta
INDUSTRIAL
CITY TEL. NO. WASTE APPROVAL
PLUMBER (71� -INSPECTION RECORD
ADDRESS D O , Ix
CITY TEL. NO.
LICENSE NO. J44 OVtl ^ OA p
NUMBER TYPE OF FIXTURE OR ITEM FEE i 4L r C"1 C HO p B. G Ir&m V u
WATER CLOSET (TOILET) 59 n
CP,12 VA
BATH TUB �� ^gyp IZ �� ,•Jgp A
SHOWER
LAVATORY (WASH BASIN) _-Y. / I
KITCHEN SINK '0�-"5-� 17 � .\1 'FG 4, bA �C) bO pl
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER -
TOTAL NO. @ 0.e0 - APPROVALS
DATE INSPECTOR'S SIGNATURE
CAS SYSTEM OUTLETS ! @ 1.00
— UNDER SLAB WORK I
WATER HEATER ® 1.00 ROUGH PLUMBING
PERMIT $ 1 00 GAS PIPING
TOTAL FEE '95 GAS VENT
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGYLATING PLUMBING FIXTURES
PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO. NOTIFIED
CALIFORNIA OR THAT I AM THE GA LO NE HE ABOVE
DESCRIBED RESIDENTI L PROPERTY
SIGNATURE
OF
SIGNATURE
T - FINAL LJ 1!\L(Y
WILLIAM J. FOX, UNTY ENGINEER VALIDATION
',&2 9 6 8S nwt25 3 4.40 0
BY
DEPUTY
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