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76A667-CE817 3-59
APPLICATION -FOR PLUMBING PERMIT �
COUNTY OF LOS ANGELES
DEPARTMENT.OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING �� ��
JOHN A. LAMBIE, County. Engineer ADDRESS / ✓� ANCASSATT D. GRIFFIN, Sup t of Building LOCALITY
FOR APPLICANT TO FILL IN NEARESTI�
CROSS ST. Z o siq A-} ,F,
NUMBER FIXTURE OR ITEM t
OWNER �t t_+. e-P_
WATER CLOSET MAIL
BATH TUB ADDRESS � 4-7 ��-j-o A,1 n vC� �z
CITY �; /�'% P-y TEL
SHOWER L. NO :P! 9 C3
f -�
CONTRACTOR
LAVATORY
' SINK ADDRESS .L AA]_
A A i.
CITY
DISHWASHER �C. TEL. NO.fi'---
CONT
ACTOR'S
STATE
LAUNDRY TUB REGTEL.
ON NO. / `, COUNTY�❑`
CLOTHES WASHER DISTRICT NO. GaQW ONE PR ESSED BY I
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
ELZV
A-7 72.RL P141";5 IiZf
@ $1.00 PER ITEM ur0 �✓f/`b!,� N07'GffF/J !-/�lil C19 /Vile�.- OR FIXTURE $ ( APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE --A 0:2-0ROUGH PLUMBING G-R� � 4 ,.Am&hl
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL' COUNTY ORDINANCES AND .STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
� /cCl�1 ,.,�,.rt-
I HEREBY CERTIFY .THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES /,1'x''2'7-4/.I ��ryyI�ij,��Ipy_flV _-
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEG L OWNER OF THE ABOVE' -
DESCRIBED RESIDENTI ^PROPERTY,
UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITT x'
FINAL r-�-�".�t�� (�71i IIUL��JIWGId'
®P VALIDATI ROBERT A. WOOD.
CK.. M.o. CASH I SUPERVISING MECHANICAL ENG'R
76A667 OBS 17 11-50 1 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
NE PERMIT Nu.
FOR APPLICANT TO FILL IN ISTR T O. O P O
2 3 poi
PLUMBER RECEIVED READY FOR BY D E I9 UED
FIRST INSPECTION
ADDRESS
CITY Gy V li TEL.-No. ADDRESS 9 7 I 1`l
COUNTY LOCALITY
LICENSE NO. EXPIRES
NEAREST
PERMIT FEES CROSS ST. Q /
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER G 1/I
MAIL $9[Y r?
WATER CLOSET(TOILET) 0 0.50 $ ADDRESS ''II
BATH TUB @ 0.50 CITY ' TEL NO.
SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) @ O.SO APPLICATION AND STATE THAT THE ABOVE 18 CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE. OR 1 AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
GAS SYSTEM OUTLETS @ 0.50
SIGNATURE OF
WATER HEATER @ O.SO PERMITTEE_
SLOP SINK @ 0.50 INSPECTION RECORD
FLOOR SINK @ 0.50
FLOOR DRAIN @ 0.50 -
DISHWASHER @ 0.50
DRINKING FOUNTAIN @ 0.50
URINAL @ 0.50 ,t`;l..' i' ')I N�P>i k"!�.'� -•'1 �.C �~ J
HOUSE SEWER @ 0.50 n ��I �I �'�,:,��el:F'=t s r^:f. '� Z
MISCELLANEOUS �r ,S•D�L /��.± W '.�1�%�
�N f Tr�NYG v VIC—) O
APPROVALS
DATE INSPECTOR'S NAME
ROUGH .PLUMBING neoV9 Z 9,lrn.
z-G
GAS PIPING Kz'1 Y
GAS VENT
CESSPOOL @ 1.00 CESSPOOL
SEPTIC TANK: SEPTIC-TANK ..l,
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT I 1.00 GAS TEST V
a UTILITY CO.NOTIFIED
TOTAL FEE S Z cU�`^'
FINAL "lr�l.