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CE 877 8-56 1APPLICA` IO-N F®R �PLI� sNGPERMIT .
BUILDING AND SAFETY DIVISION
Department,of County Engineer
County of Los Angeles BUIL131NG
JOHN A. LAMBIE.COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUPT OF BUILDING �� A� / /_
LOCALITY (j („�/t
FOR APPLICANT TO-FILL IN NEAREST
,,�,/ �/' I CROSS.ST. `
OWNER /�[J� %.{/���G ,///�-/jl �(��l �D /e- DISTRICT NO. GROUP ZONE-, READY FOR INSPECTION
MAIL
ADDRESS 11 6e-,. 221 °
CITY �b'.',i ,Geri N TEL. NO. Arg lI INDUSTRIAL -
WASTE APPROVAL {
' PLUMBER
INSPECTIONf RECORD
ADDRESS
CITY nTEL. NO. ,��
LICENSE NO. -/3 ,�� L- Y/�/ �S'�l'J, L/A4F
NUMBER TYPE OF FIXTURE OR ITEM FEE 4)DO / .10U,e A1,2,9K
WATER CLOSET (TOILET) "-@" $1.00 $ Ln12Y 7-9h)/ -re) S15,16IA Cr 10"
BATH TUB - @ $1.00 �' -T4. R-6If ' - lMz�-Al
1C
SHOWER _ @ $1.00 f 7 ti � .l�/ U d6#/-,,as'
L.AVATORY.(WASH BASIN) @. $1.00 ' - •_,..
KITCHEN SINK @ $1.00
DISHWASHER @ $1.00 415d:::77Lb,
LAUNDRY-TUB OR TRAY @ $1..00
CLOTHES WASHER @ $1.00
' � �3 To 1 LFT -7214�
WATER HEATER @ $1.00
GAS SYSTEM - @ .$1.00 "' `- ' w/n y z � '� �
APPROVALS
DATE INSPECTORS SIGNATURE
UNDER SLAB WgRK
ROUGHPLUMBIN• - x 6"/ JU L1 !1^ /r"""'
PERMIT $ 1 00
" GAS PIPING
TOTAL FEE GAS VENr !
NHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION — .
Ar),�(p � 0 !'f�tv1°�+'a�u�
STATE THAT THE ABOVE IS CORRECT AND 'AGREE TO COMPLY HOT WATER,HEATER`
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMB
PLUMBING. -
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST
"LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED -
DESCRIBED: RESIDENTIAL PROBE TY. , - -
SIGNATURE .� �
OF PERMITTEE FINAL y 6•�td'S t�`:�F'.'i6ti%14�.( f
ROBERT A.WOOD,
JOHN,A. LAMBIE COUNTY ENGINEERVALIDATION SUPERVISING,MECHANICAL ENG'R
. _GK M.0. CASH