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DBS--117 12•54 APPLICATION FOR PLUMBING .PERMIT
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DIVISION OF BUILDING•AND SAFETY 1:
Deportment of County Engineer
.Gpunty of LoB,Angeles
WM.J.'FOX, COUNTY ENGINEER BUILDING
ADDRESS
CASSATT D. GRIFFIN, SUIP'T OF BUILDING,
_FOR APPLICANT TO FILL IN NEAREST r
ROSS ST:'
OWNER DIST ICT NO. GRO -//�,7 / READY FOP INSPECTION
MAIL
ADDRESS
INDUSCITY ^- TEL NO V'
WASTE TA APPROVAL
PLUMBER .�. ,.�, - . {INSPECTION RECORD
ADDRESS - -
CITY TEL. NO
LICENSE NO.
NUMBER -TYPE OF FIXTURE OR,ITEM FEE
WATER CLOSET (TOILET) -
BATH TUB
SHOWER
LAVATORY'(-WASH BASIN) ,
KITCHEN SINK
DISHWASHER
LAUNDRY TUB OR TRAY '
TOTAL NO. @ 0.80 APPROVALS
.. DATE INSPECTOR'S SIGNATURE
GAS SYSTEM � OUTLETS @ 1.00 -
WATER HEATER @ '1.00 UNDER SLAB WORK
ROUGH PLUMBING �1 11 'S 4_ /'•Pf l.t.�o
PERMIT S I t OO GAS PIPING
TOTAL FEE 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
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGWLATING PLUMBING FIXTURES
PLUMBING. '
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO. NOTIFIED '
CALIFORNIA OR THAT I_ AM THE LEGAL OWNER' OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY.
SIGNATURE
OF PERMITTEE a aw=k_Li-
FINAL
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WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
..: .2 1 Pyr 31 . . 3 3A '0
BY
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