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COUNTY OF LOS ANGELES APPLICATION F1 PE/'..lRMIT
Department of County Engineer PLUMBING
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer
D S' NO. GROUP ZONE RM .
FOR APPLICANT TO FILL IN --- �
1/,v-/
PLUMBER R I READY FOR I EFIRST INSPECTION //EADDRESH /
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SUJLDI ��� ,.•� / �y 3
CITY - �"•` ,.- P" TEL No. ADORE
COUNTY •„7 f,-:' LOCALITY •� �,-f
LICENSE N0. EXPIRES
NEAREST RA fl.4`
PERMIT FEES _CROSS STT. , //] i
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER4_ e •!•�J� , � f J�q y�i
ADDRESB-JA r /- A R ` 44()
WATER CLOSET(TOILET) @ 0.50 $ j�_ y-
BATH TUB (9 0.50 D CITY ^
,I'&,�^ C'' `Y TEL NO.
SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 OFGTHESRES DENT ACOUNTY LL PROPERTYENSE, OR I DWCRIIBEDLEGAL
ABOVE.OWNER
GAS BYSTEM—'�—fOUTLETS 0.50 (/(/ SIGNATURE ❑F +�
WATER HEATER @ 0.50
D PERMITTEE
SLOP SINK @ D.50 SPECTI N RECORD
FLOOR SINK @ 0.50
FLOOR DRAIN @ 0.50
DISHWASHER @ 0.50
DRINKING FOUNTAIN @ 0.50
URINAL @ 0.50
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HOUSE SEWER @ 0.50 _Z
MISCELLANEOUS
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O
APPROVALS
' DATE INSPECT NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
n
CESSPOOL 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK All
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DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT 1.00 GAS TEST
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TOTAL FEE
UTILITY CO. NOTIFIED�•
FINAL
76A667 DBS$r 17 6-52