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DBs.IT 10-55
APPLICATION FOR PLUMBING PERMIT 1
DIVISION OF BUILDING AND SAFETY
Depw hent of County Engineer
County of Los Angeles BUILDING Lt
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 5 ��j'/
CASSATT D. GRIFFIN, SUP'TOFBwLDIN.
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
OWNER / DISTRICT NO. GROUP ZONE READY FOR INSPECTION.
MAIL / T
ADDRESS V � ...F
INDUSTRIAL (
CITY TEL. NO. WASTE APPROVAL
PLUMBER6 ,/¢_.QJ.y�' �,.��/� INSPECTION RECORD
ADDRESS !/ -2�
CITY L.
NO// —
LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 $ v K I
BATH TUB @ $1.00 Dia
SHOWER @ $1.00 Q ::ff
LAVATORY (WASH BASIN) @ $1.00 QiI
KITCHEN SINK @ $1.00 d
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER - @ $1.00 O
WATER HEATER @ $1.00 1 ��
GAS SYSTEM @ $1.00
APPROVALS
T I SPECTOR'S YGNATURE
UNDER SLAB WORK /
PERMIT $ 1 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE A
GAS VENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS 9PPLICATIGN
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY HOT WATER HEATER dr.
WITH ALL COUNTY ORDINAN CE5 AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
IITEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED ��
DESCRIBED RESIDENTIAL PROPS Y.
SIGNATURE
OF PERMITTE FINAL
JOHN A. LAMBIE. r-OUNI<ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
/eiTt'T x.a. cAsx ,
1 0 8 a1 AUG13 3 . 12-00