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76A667 DB917 11-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER PLUMBING 1
FOR APPLICANT TO FILL IN DISTRICT NO. GR.OU OE PERMIT NLI.
4-
PLUMBER READY FOR
RECEIVED MY
5, FIRSTIN9PECTION DATE ISSUED_
ADDRESSBUILDING
�D�
CITY � TEL. NO. ADDRESS O �O
COUNTY
LOCALITYLICENSE J2 C
NEAREST IF
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET(TOILET) D.50 S ADDRESS 10 f .I�if
BATH TUB @ 0.50
CITY-;ti �;,
d—�(' F, -, TEL No.
SHOWER @ O.SO IHEREBi ACKNOWL DGE 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.
I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY (9) 0.50 ANGELES COUNTY LI �JSE. OR I AM THE LEGAL OWNER
OF THE RESIDENTIERTY D CRIBED ABOVE.
GAS SYSTEM OUTLETS 0.50 i
SIGNATURE OF
WATER HEATER 0.50 PERMITTE
SLOP SINK @ 0.50 INSP &TION RECORD
FLOOR SINK @ 0.50
FLOOR DRAIN Q 0.50
DISHWASHER 0.50
DRINKING FOUNTAIN 0.50
URINAL @ 0.50 J
Q
HOUSE SEWER @ 0.50 _Z
MISCELLANEOUS O
Ir
O
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT 1.00 GAS TEST
UTILITY CO.NOTIFIED
TOTAL FEE / O FINAL
F
79AA417 D=17 „-•a APPLICATION FOR PEHI4IT
DEPARTMENT OFNCi AND SAFETY PLUMBING i
COUNTY OFF IDS IAS A.NCi�£.L.ES
WILLIAM LL FTM OHIv ENaIN[=
FOR APPLICANT TO FILL IN e5—-2-6 P�
PWNB[RRGDY FORImico
N� FIRlT INflPEOTION DAT[ 17-
ADDREW
■UILDIHD
CITYTEL Ho - ADORED
COUNTY I nn4kI ITY
H[7\R[tT
flL+p�OT FMS ORO=RT.
NUMBER Type or rl3 N=RI OR ITCH FL[ Q +IR
MAIL ► f f
WATER cumi T(TOILET) • 0.60 • ADDRLM
BATH TUN ! 0.60 OITY TEL H0.
■HCWER • 0.60 1 Hr'PUMY AOKNOWLEDOE THAT 1 HAV[ READ T'HI■
LAVATORY (W/1!•H RAIIH) • 0.60 APPLICATION AND (TATE THAT THE MOVE IN ODRRECT
Alm AORQ TD OONPLY WITH ALL COUNTY ORDINAMOMM
KITCHEN RINK • 0.KO AND NATE LAWN REOULATINO PLUMNIHO.
I CERTIFY THAT I POs rHK .DOVE V D LOR
LAUNDRY TUN OR TRAY ! 0.R0 AMOMAN DOUNTY UO[ME14 OR I AM TH[ OWIiER
OF THE RERIDENTIAL PROPERTY DMOR1R[D AX01 L
OAs MT[k O UTL KT7 ! 0.60 6
■I�NATUR[ DF
WATER HEATER • 0.EO PERH
SLOP MINK • 0.KO IN SPECMN RECORD
FLOOR MINK ! O W
FLOOR DRAIN • 0.60
DIOHWAIHIC! ! 0.W
DRINKING PIMJKrA]N ! CLEC
URINAL • 0.60
HOUM SEWER • o.so _
M I fO[CLAN[cnm
O
APPROVAIS
DATK im=- D4'Ow■ MA>4z
ROUGH PWNEINO
OAR PIPINO
MAD VENT
EHC�OOL • 7.'00 0[APPOOL
033rrIO TANKI ■aT1O TANK
DRAIN ( ) PIT • 1.00 ■LVVKR
PERMIT i.Oo a" TEST
UTIUTY C0.NOTIFIED
O
TTAL FEE
rlKAL