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DBS APPLICATION FOR PLUMBING PERMIT 1
(DIVISION OF BUILDING AND SAFETY
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS , O.V
CASSATT D. GRIFFIN,SUP T OF BUILDING ` /� �' �
LOCALITY Q M
FOR APPLICANT TO FILL IN I NEAREST
GROSS ST. ✓
OWNER D e DISTRICT NO. GROUP_ I I READY FOR INSPECTION
MAIL (T/
ADDRESS
CITY /1 TEL. NO. INDUSTRIALWASTE APPROVAL
PLUMBER N e./C d ,i F ']—rIL/I,6.e7` INSPECTION RECORD
ADDRESS L2 x '.j
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CITY I�P� TEL. NO.
� / J
_LICENSE NO. 7 / :3(i
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 00
BATH TUB @ $1.00 0.0
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1.00 '(J
KITCHEN SINK @ .FTI.00
DISHWASHER @ 51.00
LAUNDRY TUB OR TRAY @ $1.00 OW
CLOTHES WASHER @ $1.00 O
WATER HEATER @ $1.00
GAS SYSTEM @ $1.00 90
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK (
PERMIT $ 1 00 ROUGH PLUMBING
OD GAS PIPING
TOTAL FEE La GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF tU�
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIAL P ER Y. , d
SIGNATURE
OF PERMITTEE C FINAL /t)�J
JOHN A. LAMBIE. COUNT ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
/ C[R Y.0. GSH
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