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DEPARTMENT OF COUNTY ENGINEER PLUMBING 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BU I LD I N G
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS
FOR APPLICANT TO FILL IN LOCALITY Co
BUILDING �O +�. NEAREST CROSS ST.
ADDRESS r,¢.�,(
DISTRICT NO. GROUP �jZONE PERMIT NO.
LOCALITY s I(Ar�� 1s 2 O
NEAREST Y 3!
CROSS ST. O a t RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL INDUSTRIAL
ADDRESS WASTE APPROVAL
CITY TEL,NO. INSPECTION RECORD
PLUMBER
s
ADDRESS O • tt 2 '1 r
CITY TEL.N0. g'Y 6 a Im in 1"'C.►1 h�P.%,®
L ❑STATE ) r ,� .r ,(z.. P 01.1- 'e^� �.s...
LICENSE NO. CfY
PERMIT FEES a
s z
DUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET(TOILET) @ 0.80
BATHTUB @ 0.80 �� iT' anL���� �L7 �54 (_. 13
SHOWER @ 0.80 r
LAVATORY(WASH BASIN) @ 0.80 I -
KITCHEN SINK @ 0.80 L
S C76
LAUNDRY TUB OR TRAY @ 0.80 <
SLOP SINK @ 0.80 0
FLOORSINK @ 0.80
FLOOR DRAIN @ 0.80
DISHWASHER @ 0.80
DRINKING FOUNTAIN @ 0.80
URINAL @ 0-80
GAS SYSTEM-_-_�-._..__OUTLETS @ 1.00
WATER HEATER W `Y'E @ 1.00
MISCELLANEOUS
APPROVALS
DATE I NSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
TOTAL FEE GAS PIPING
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- GAS VENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE---
FINAL
76A667 DBS 17
i Cdb 12-53