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DEPARTMENT OF COUNTY ENGINEER P L U B' N
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
BUILDING /
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS
LOCALITY
BUILDING
FS �APPLICANT TO FILL IN NEAREST ADDRESS CROSS ST ��(it
,
DISTRICT NO. GROUP � PERMI 0.
LOCALITY � �
NEAREST
CROSS ST „p � e RECEIVED Ready for Inspection DATE ISSUED'(,
OWNER A /`/{,�Jl/Y- w/�
MAIL11 AAAl INDUSTRIAL
ADDRESSJ WASTE APPROVAL
O,
CITY " A � 4 f.A , n TEL.NO � - -9 INSPECTION RECORD
PLUMBER ('.CJIJ Yll,
a"J44t
ADDRESS I 3'1(�
CITY Ww' ,A gAUL� , \ TEL.NO.
/ ❑STATE
LICENSE NO. 6 I p-COUNTY
J
PERMIT FEES a
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NUMBER TYPE OF FIXTURE OR ITEM FEE
n
WATER CLOSET(TOILET) @ 080 $ (/
T ❑
1 BATH TUB @ 080
SHOWER @ 08080
�— LAVATORY (WASH BASIN) @ 0 80
KITCHEN SINK @ 080 �d
LAUNDRY TUB OR TRAY @ 080 Q
SLOP SINK @ 080
FLOOR SINK @ 080
FLOOR DRAIN @ 080
DISHWASHER @ 0 80
DRINKING FOUNTAIN @ 080
URINAL @ 080
GASSYSTEM OUTLET8 @ 100
WATER HEATER - @ 1 00 1 44
ISCELL NEOUS�
//U -yo APPROVALS
DATE' INSPECTOR'S SIGNATURE
UNDER SLAB WORK /
PERMIT' $ ,1 00 ROUGH PLUMBING /').,A
TOTAL FEE 1 U �.D GAS PIPING
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- GAS VENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST /+
AND STATE OF CALIFORNIA OR THAI') AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED R ID TIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTE _ __. _. _.
FINAL
76A667 DBS 17 1/53