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DSAPPLICATION FOR PLUMBING PERMIT
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DMSION OF BUILDING AND SAFETY
Department of County Engineer
Co=ty of Los Angeles
WM. J. FOX, COUNTY ENGINEER AODR EISS CA� J /L• �/(CG//V6��T
CASSATT D. GRIFFIN, SUPT OF BUILDING
FOR APPLIC NT TO FILL IN NEARESrY ^i5/'p/mGi�nn C/�"
CROSS ST.
OWNER!L— DISTRICT NO. GROUAl
P ` ZONE xenoT Pox INSPECTION
ADDRESS J /� 1 /0
INDUSTRIAL
CITY EL, NO. WASTE APPROVAL
PLUMBER INSPECTION RECORD
ADDRESS
CITY
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. @ O.SO APPROVALS '
— DATE INSPECTOR'S SIGNATURE
GAS SYSTEM OUTLETS (Rl 1.00 _
�• UNDER SLAB WORK
WATER HEATER (? 1.00 �
ROUGH PLUMBING _
PERMIT 5 �� GAS PIPING
_ TOTAL FEE 00 GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HE _
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES _
PLUMBING.
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO. NOTIFIED
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY.
SIGNATURE p
OFPERMITTE '� FINAL
WILLIAM J. FOX, COUNTY ENGINEER V IDATION
CO3 7 5 1 14AY 16 3 2.0 0
BY
( � DEPUTY ..
76AB67-=17 3-59 -
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER - OPROCESSED
BUILDING AND SAFETY DIVISION
IOHN A. LAMBIE. Couvtp Evg neeCASSATT DGRIFFIN, Sup I of Building LOCALITY iii1(1
FOR APPLICANT TO FILL IN NEARESTCROSS ST.NUMBER FIXTURE OR ITEMOWNERWATER CLOSET / „ S /ADDRESS �BATH TUB /SHOWERTEL. NO.
LAVATORYCONTRACTORSINK ADDRESS / IDISHWASHER CITY�1:1,, '�4 TEL.CONTRA TOR'S U LAUNDRY TUB " REGISTRATION NO. ❑CLOTHES WASHER DISTR�NO. GROUP ZONEBY
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL '
INSPECTION RECORD
a $1.00 PER ITEM {
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
%, ROUGH PLUMBING
TOTAL FEE V
GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AN STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I:"'AM E LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENT] PRO RTY. j UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTE FINAL
VALIDATION^ ROBERT A. WOOD,
05. M.o. CASH SUPERVISING MECHANICAL ENG'R -
1r F 3
.T(C 5 A 5.0 0 t-