HomeMy Public PortalAbout5609 GRACEWOOD AVE_Building__ I
TEMPLE CITY
7CA638A CE*803 ,. APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
ADDRESS
DEPARTMENT OF COUNTY ENGINEEII
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JZN8KN, /UP'T OF BUILDING CROSS ST.
D L�rE_RICT�fI G TYPE P ESS Y
FOR APPLICANT TO FILL IN P CONST. CZ�
BUILDING STATISTICAL C CATION SEWER MAP
ADDRESS 5609 N. Grac ood Temple Ci BK PG
CLASS. NO. DWELL. UNITS
LOT NO. BLOCK WATER
CERTIFICATE: NOT REQUIRED11 1-1
RECEIVED
TRACT o� `� NAO. /i 0 ({ciRcLEE) STATE MAJOR SECOND, LOCAL
NO.OF BLDGB, V
SIZE OF LOT NOW ON LOT USE ZONE 9PECIAL
USE OF CONDITIONS
EXISTING BLDG.
TEL-
OWNER
ELOWNER NO. BUILDING EXIST.
SETBACK YARD HWY STREET NAME WIDTH
ADDRESS FRONT
ARCHITECT OR, TEL P. L
ENGINEER NO. SIDE
P. L.
ADDRESS
CONTRACTORVir in Roof Co No
ADDRESS
600 S. San Gabrit-1 "Rlvfi-
0
DESCRIPTION OF WORK
eroo
NEW ADD ALTER REPAIR DEMOLISH
SQ.FT. NO.OF NO. OF
SIZE ST RIES FAMILIES
USE OF
STRUCTURE
SIGNATURE OF
APPLICANT
VALUATION S
155.00 .
APPROVALS DATE INSPECTOR'S SIGNATURE
P PMT FOUNDATION: LOCATION
FEE S FEE S4 00
FORMS, MATERIALS
FRAME: FIRE STOPS,
I HERMY AC'KNOWLSDGQ THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STAT[ THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION.
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
SU ILDI NG CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HERESY I WILL NOT "PLOY ANY F[RaON IN VIO LATH. INT.
TION OF THE ��=FTA OF GLIFORHIA RL
ENG TO WOi1KM[ SC[. LATH. EXT.
SIGNATURE OHOUSE NUMBER COR-
PERMITTEE -1-4RECT AND POSTED
ADDRESS 600 .S SaII Gahr1P1 R1yd FINAL
SII Gabriel, a ornia JOHN F. LEWIS. PRINCIPAL STRUGT .' ENG EER
PLAN CHECK VALIDATION CK. M.o. cAAH PERMIT VALIDATION
,9 8 4� .M 1 1 D. 4.00- v
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71AS1U.D1111-3 11.64 _
APPLICATION FOR BUIUNNG .PERMIT I.
BUILD
DMSION OF BUILDING AND SING
AFETY AD--a .Es cc w o 41
0
D.parU-at of County Engt—
Couhty of Los Angeles LOCALITY 14
WM.J. FOX. COUNTY ENa1NKKA NEAREST'
CASSATT D.GRIPPIN. Su-I-T OF BUILDING CROSS ST.
DISTRR NO. 1 0 U ,r,YPa JOER A
ER MP
FOR APPLI TO FILL IN ��YL^
- CONST.
BUILDING -
ADDRESS 47 4 MAPA Q STAY YES JaO
NUM7ER
LOT NO. ., U;E ZONE SPECIAL
CONDITIONS- "
TRACT
NO. OF DLDOH. �
SIZE OF LOT NOW ON LOT BUILDING YARD HWY STREET NAM[ EXIST.
USE OF - SETBACK WIDTH
EXISTING BLDG. FRONT �1.•I
1
P. L LSV
OWNER HIDE
MAIL
ADDRESS d '-
TSL' DWELL 1 UNIT 15 INDUSTRIAL
CITY NO. -
2 DUPI Rx UNIT d PUBLIC BLDG
ARCHITECT OR TEL "
ENGINEER NO. 3 APT UNIT '7 ADDN.,ALT.,
ADDRESS. 4 COMMERCIAL B RECORD TE
CONTRACTOR 'NOL
IN"
E=ON RECORD
ADDRESS - y
DESCRIEMON OF WORK
NEW ADD ALTERREPAIR DEMOLISH
NO. OF NO. OF
LIZE STORIES FAMILIES
USE OF STRUCTU
SIGNATURE OF
APPLICANT APPROVALS
ADDRESS DATE INSPECTORS SIGNATURE
FOUNDATION: LOCATION r'J'
d O P. C. FORMS, MATERIALS 1
FEE FRAME:FIRE STOPS.
VALUATION • O BRACING DOLTS'
FEE FURNACE: LOCATIS
ON, -
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS OAS VENT DUCT
APPLICATION AND STATE THAT -GHE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY-ORDINANCES LATH INT.
AND STATE LAWS REGULATING BUILDING CONSTRUCT
-TION. LATH, EXT,
SIGNATURE OF HOUSE NUMBER COR-
P... RECT AND POSTED
ADD'RFrS8 I FINAL
.MM;!;�1. FOX. Couwry rLNGINxm VALIDATION
BY 'ti DEPUTY BY .O Q UTY
X0-35261S a 26
&1Y '' BY
m DELI
P -CY - DEPUTY
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DSS-3 25M SETS 8-45
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES BUILDING UIL ® 1NG
WM. J. FOX, CHIEF ENGINEER -
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
1� DISTRICT NO. PLAN CK. NO. PERMIT NO.
BUILDN
ADDRESS
LOCALITY RECEIVED BY DATE OF APPL. DATE 169UED
NEAREST
_CROSS ST.
� BUILDING
OWNER _ f �g1..`v..g,: ! �x ADDRESS
MAIL
ADDRESS LOCALITY
L./+
-T NEAREST
d TEL. CROSS ST.
CITY ` t�Y NO. ,
FIRE NO.OF i TYPE �I GROUP
ARCHITECT OR TEL. ZONE PLANS
ENGINEER NO.
BLDG. ORD. NO.
ADDRESS SETBACK LINE
APPROVED
TEL. BY DATE
CONTRACTOR NO, j
USE APPROVED
ADDRESS ZONE BY DATE
LEGAL
DESCRIPTION LOT NO. I BLOCK CORRECTIONS
TRACT -- l
t
NO. OF SLOGS.
SIZE OF LOT 2 o Q I NOW ON LOT _
V
USE OF EXNO.OF I NO. 13F
_LISTING BLDG. e' FAMILIES ROOMS =.�d
DESCRIPTION OF WORK
NEW - - ALTERATION ADDITION O
A.
REPAIR MOVING I DEMOLISH Ei
Sq. FT. NO.OF /
SIZE /fj ROOMS STORIES I /// l Q7i ''' < /' �I - r
WALL'""�' ROOF /l
COVERING I COVERING lL
USE OF NEW `-
BUILDING 1
I
I
APPROVALS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION, INSPECTOR DATE
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS,
BRACING, BOLTS
SIGNATURE OF
OWNER LATH, INT.:
AUTHORIZED AGT — LATH, EXT.:
$ p C $ PLASTER, INT.
FEE _ __ PLASTER, EXT.
$
VALUATION FINAL
FEE
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES S '
WM. J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
DISTRICT NO. PLAN CK.NO. PERMIT NO.
BUILDING !�/3 �.�- -, 9
ADDRESS
LOCALITY i RECEIVED BY DATE OF APPL. DATEISSUED
NEAREST R — ( 17-4
CROSS ST.
�'"� BUILDING
OWNER . ,�Cyi/I-l: ADDRESS
MAIL �' LOCALITY r
ADDRESS
NEAREST
TEL. CROSS ST. i
CITY NO.
FIRE NO.OF TYPE GIlOUP �`
ARCHITECT OR TEL ZONE PLANS
ENGINEER NO.
BO O.
ADDRESS SETBETB ACK LINE
APPROVED
TEL. BY DATE
CONTRACTOR NO.
USE APPROVED
ADDRESS ZONE BY DATE
LEGALCORRECTIONS
DESCRIPTION LOT NO. B OC
TRAcil
NO.OF BLDSS.
SIZE OF LOT I NOW ON LOT i
USE OF NO.OF NO.OF
EXISTING BLDG.' I FAMILIES I ROOMS
DESCRIPTION OF WORK
NEW ALTERATION �_j_ADDIIONAREPAIR MOVING DEMOTLISH yj
SQ.FT. NO.OF / Z
SIZE V ROOMS ,( STORIES
WALL C I ROOF
COVERING �) /'�r^(�d 4 COVERING
USE OF NEW -
BUILDING Q_LJ d--FSC.
c
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION .INSPECTOR DATE
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS -
AND STATE LAWS REGULATIWG BUILDING CONSTRUCTION.
FRAME: FIRE STOPS, '
SIGNATURE OF BRACING,BOLTS
PERMITTEE_ LATH,INT.:
AUTHORIZED AST LATH,EXT.:
Des-3 SOM SETS 1-4e $ pp P.C., PLASTER,INT.
FEE PLASTER,EXT.
VALUATION
FEE FINAL
I
-DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES BUILDING
WM. J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL INFOR OFFICE USE ONLY
DISTRICT NO. PLAN CK. NO. PERMIT NO.
BUILDING 1/ O
ADDRESS 7
LOCALITY RECEIVED BY DATE OF APPL. DATE ISSUED
CROSS ST. w 'vy
BUILDING ADDRESS ,j 0 / �r'�PAC,E'W f1 'D
OWNER
MAIL LOCALITY/^//CCA�OlEJ
ADDRESS •y ) NEAREST olO�
TEL. CROSS ST, v Y
CITY NO. FIRE NO. OF I TYPE I GROUP-
ARCHITECT OR TEL. ZONE PLANS
ENGINEER Q ' NO. BLDG.
SETBACK LINE
ADDRESS r r, APPROVED
TEL. BY DATE
CONTRACTOR ,,, NO. USE ,/ APPROVED
ZONE✓y _ f BY DATE
ADDRESS Sr L� HOUSE NUMBERING
LEGAL /SV 9
DESCRIPTION LOT NO. �I O BLOCK MAP NUMBEROQ FIELD CHECK BY
TRACT �� - NO. ASSIGNED BY DATE
NO. OF BLDGS. CORRECTIONS _
SIZE OF LOT r i° NOW ON LOT 1_ n ,, y / �1�.`� /.e%.'
,.';'
USE OF y� C NO. OF / OC, i
EXISTING BLDG, !J W C�(l n r �. p plli-4FAMILINS �� 7 -7-
DESCRIPTION OF WORK
-� 1-7
�V NS
NEW I I ALTERATION I I ADDITION m ,
/,!t" ?" O
REPAIR I I DEMOLITION I I I
/� C 7-1 �-
SIZE S7 ROOMS Ll
SQ. FT. NO OF ,j{ STORIES _ Z
EXT. WALL ROOF r
COVERING (�( ! COVERING
USE OF STRUCTURE
APPROVALS
i INSPECTT9R'S SIGNATURE DATE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION: LOCATION r
PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS i L %rf�✓ �' '
CORRECT.
1 AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS,
HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS
� 'l
4 ..
LAWS REGULATING BUILDING COSTR TION._ FURNACE: LOCATION,
SIGNATURE OF I GAS VENT, DUCTS
PERMITTER
LATH, INT.
ADDRESS
LATH, EXT.
AUTHORIZED AGT.
ASTER, INT.
�CA638A• DBss $ P. C.
v FEE PLASTER, EXT.
VALUATION IVVP FEE $ GC i FINAL
I � �
D.B.S.-17 25M SETS 12-45 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES P�u�B��G
WM.J. FOX, CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO.
ROUGH FIXTURES COMPLETE ! U +'
READY FOR pA E ISSUED
HEATER CESSPOOL 1-1 SEPTIC TANK RECEIVED BY FIRST INSPECTION
GAS MISCELLANEOUS ! '
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY,
JOB
c _NAME ADDRESS
W
ADDRESS LOCALITY t
J NEAREST
G CITY TEL.No. _ CROSS ST.
COUNTY
CERT.No. EXPIRES S NAME
LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL
ADDRESS
NORTH O ------ _-----
CITY TEL.No.
I AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION.
!LUMBER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
3 a OWNER
CORRECTION'S
SOUTH
a
DESCRIPTION OF WORK yp�
PATH TUB FURNACE
►r
SHOWER DISHWASHER a'
_ O
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN
DATE INSPECTOR'S NAME
WATER HEATER DENTAL LAVATORY
ROUGH PLUMBING �
METER GAS SODA FOUNTAIN GAS PIPING
OUTL
GAS VENT �I
CESSPOOL
TOTAL NUMBER OF FIXTURES SEPTIC TANK
CESSPOOL SEPTIC TANK SEWER
TOTAL FEE UTILITY CO.NOTIFIED I� � .,./f Q
FINAL
r
D.B. 17 25M SETS 12-43 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY PLUMBING
COUNTY OF LOS ANGELES E
t WM.J. FOX. CHIEF NGINEER
NATURE OF INSTALLATION DISTRICT-NO. GROUP ZONE PERMIT NO.
ROUGH FIXTURES COMPLETE
�v
HEATER CESSPOOL 1-1 SEPTIC TANK RECEIVED BY READY FOR
DATE ISSUED
� f FIRST INSPECTION
GAS MISCELLANEOUS
APP CANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB
Q. NAME / ADDRESS
W
In ADDRESS LOCALITY
NEAREST
A CITY TEL.No. CROSS ST. - r
COUNTY
CERT.No. EXPIRES C NAME
W
LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL
NADDRESS
NORTH 0 G
CITY TEL.No.
I AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF 0ULI,KATION.
UMBER
I AM THE LEGAL OWNER OF THE PFS PERTY DESCRIBED
ABOVE.
� i
CORRECTIONS
L3
SOUTH J
DESCRIPTION OF WORK _z
BATH TUB FURNACE
IY
SHOWER DISHWASHER D
LAVATORY REFRIGERATOR /
KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
_SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN /DATE INSPECTOR'S NAME
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING 7
METER GAS SODA FOUNTAIN GAS PIPING
OUTL
GAS VENT
CESSPOOL
TOTAL NUMBER OF FIXTURES 1_ SEPTIC TANK I I
CESSPOOI SEPTIC TANK SEWER I
$ UTILITY CO.NOTIFIED I
TOTAL FEE
FINAL
76 A 667—CE 817 8/68
APPLICATION FOR PLUMiE NG PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION rADD=RE
JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS. SUPT. OF BUILDING CALITY T
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE -
WATER CLOSET 1.50 OWNER
MAIL
BATH TUB 1.50 ADDRESS
SHOWER 1.50 CITY iE TEL. NO. Li tal LM /SS
LAVATORY 1.5 0 CONTRACTOR
SINK 1.50 ADDRESS )
DISHWASHER 1.50 CITY1�2 TEL. NO.
CLOTHES WASHER 1.50 STATE n LIC
LICENSE NO. (n CLASS
SWIMMING POOL RECEPTOR 1.50
DISTRICT NO. GROUP ZONE PROCESSED BY
LAWN SPRINKLER SYSTEM 2.00
cJ ! 1
CD t�i
WATER HEATER 1.50 INDUSTRIAL C..7WASTE APPROVAL z
GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD 0
OUTLETS OVER
U
5 PER SYSTEM •30
Z
Plan check fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FEE 8 2 0-0-
TOTAL
0TOTAL FEL:
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
city Tel. No. HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING.
[ HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE DECCRIBED RE NTIAL PROPERTY. FINAL
SIGNATURE JACK R. ALLEN, SUPER VISIN MECHANICAL ENG'R.
OF PERMITTEE f� �
PERMIT VALIDATION c K, M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
s
T' 1701� SEP 4 50 3.50
T
D.B.S.-17 25M SETS 12-45 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING 1
WM. J. FOX. CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO.
ROUGH FIXTURESIrI COMPLETEREADY FOR_
HEATER CESSPOOL I-1 SEPTIC TANK RECEIVED BY FIRST INSPECTION DATE ISSUED
GAS MISCELLANEOUS
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JO'
E NAME I '� ( %� C.� ADDRESS
■ ADDRESS Q / ( �'!" '- !� LOCALITY
NEAREST
L
CITY r"' f i���'pT4�F°/'!�" TEL.NO,�.'/j(: 7�.i- CROSS ST. .
COUNTY
CERT.NO.11 & >{ EXPIRES , `1+ C I NAME ,r,,
LOCATION OF SEPTIC TANK, OR CESSPOOL z MAIL
3 ADDRESS
NORTH U
CITY TEL. No.:
1 AM THE LEGAL POSSESSOR OF, THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF,60LLIFICATION.
PLUMBER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
A _
3 OWNER
CORRECTIONS
SOUTH
DESCRIPTION OF WORK
BATH TUB FURNACE r
a �
SHOWER DISHWASHER
i
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR BINK SAND TRAP
SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET _. DRINKING FOUNTAIN DATE INYPECTOR'f NAME
WATER HE4TER DENTAL LAVATORY ROUGH PLUMBING I
METER "fy GAS SODA FOUNTAIN GAS PIPING
OUTL I I
GAS VENT
CESSPOOL I i
TOTAL NUMBER OF FIXTURES SEPTIC TANK
CESSPOOI SEPTIC TANKSEWER
I $ UTILITY CO.NOTIFIED
ITOTAL FEE I FINAL
r
76AS67 DOS 17 7-51 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING SAFETY �'
• � 'COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
DISTRICT GROUP ZONE PER NO.
FOR APPLICANT T❑ FILL IN
PLUMBER READY FOR
RECEIVED BY FIRST INSPECTION DATE ISSUED
ADDRESS
BUILDING
CITY TEL No. ADDRESS
COUNTY LOCALITY
IC NSE NO. EXPIRES 27
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET(TOILET) @ O.SO $ ADDRESS
BATH TUB 0.50 CITY TEL. No.
SHOWER 0.50 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE 19 CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0,50 AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY (@ 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
GAS SYSTEM OUTLETS @ 0.50
SIGNATURE OF
WATER HEATER @ 0.50 PERMITTEE
SLOP SINK @ 0.50 INSPECTION RECORD r
FLOOR SINK @ O.sD C,'l�
FLOOR DRAIN @ 0.50
DISHWASHER O.SO -�">' -�S mTtJ y..Lv T'� �C+'a�4q� �►'.1 �7
DRINKING FOUNTAIN 0.50 C24V ti T 40 ^-A7'jiAJ OW
URINAL 0.50 -1
Q
HOUSE SEWER 0.50 Z
MISCELLANEOUS L7
O
APPROVALS
DATE INSPECTOR'S NAMC
I
ROUGH PLUMBING
GAP PIPING
GAS VENT
CESSPOOL @ 1,00 CESSPOOL
SEPTIC TANK: SEPTIC TANK 'i
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT . . . . 1.00 GAS TEST
UTILITY CO.NOTIFIED
TOTAL FEE $ /
FINAL