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78A667 APPLICATION FOR PLUMBING PERMIT 1
DBS.I_ 10-65
DIVISION OF BUILDING AND SAFETY
Department of County Engineer
County of Los Angeles BUILDING /^
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN,SUPT OF BUILDING !!j�
LOCALITY lLL U
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OR APPLICANT TO FILL IN NEAREST
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CROSS ST.
Q� DISTRICT NO. GROUP ZONE READY FOR INSPECTION
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INDUSTRIAL
TEL. NO. WASTEAPPROVAL
�lr R fit,qnford INSPECTION RECORD
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CITY '_Re l flnwpr TEL. NO. x E O-5 i5_ ljt�0. 97 , 7;1
LICENSE NO. 1 -3 L _
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 $ / G
BATH TUB @ $1.00 00
SHOWER @ $1.00 l
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LAVATORY (WASH BASIN) @ $1.00 O
KITCHEN SINK @ $1.00 / OO
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00
CLOTHESWASHER @ $1.00 Od
WATER HEATER @ $1.00 / GO
GAS SYSTEM @ $1.00 / O
APPROVALS
DATE INSPECTORS SIGNATURE „
, t.
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE o
GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER s t �
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
-
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESID TIAL PROPERTY.
SIGNATURE r
OF PERMITTEE FINAL
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
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