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DBS-17 APPLICATION FOR PLUMBING PERMIT .l
DBS.I7IDIVISION OF BUILDING AND SAFETY
Deportment of-County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FJ14 IN NEAREST
CROSS ST
OWNER DISTRICT NO. GROUP I ZONEji�GDY FOR INSPECTION
MAIL
ADDRES
i INDUSTRIAL
CIT TEL. WASTE APPROVAL '
PLUMBS I INSPECTION RECORD
ADDRES
CITY TEL N
LICENSE NO
NUMBER TYPE OF FIXTURE OR ITEM - FEE
WATER CLOSET (TOILET) @ $1 00 $
BATH TUB @ $1.00
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1.00
KITCHEN SINK @ $100
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $100 OO
CLOTHES WASHER @ $1 00
WATER HEATER @ $1.00
GAS SYSTEM @ $100
APPROVALS
DATE INSPECTORS SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY,LO/AN. SCOUNTY AND STATE OF
CALIFORNIA OR THAT 1 TGAL OWNER OF THE A VE UTILITY CO NOTIFIED
DESCRIBED RESIDENTIAL ROP
SIGNATURE
OF PERMITTEE
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATIO ROBERT A.WOOD, CHIEF PLBG INSPECTOR
CK. M.0. CASH
0-'0 SEP . '-S '.Q :e>t