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DBS-17 IO.55 - APPLICATION FOR `P'�LUMBING 'PERMIT .1
.DBS-1
DIVISION OF BUILDING AND SAFETY
Department of County Engineer CAM
County of Los,Angeles BUILDING
JOHN A. L-AMBIE, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING I �.
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
OWNER Q, ' DISTRICT NO. GROUP ZONE READY FOR INSPECTION
ADDRESS 3 J ( ' v -
/ INDUSTRIAL.
CITY .� t t TEL. NO. WASTE APPROVAL
PLUMBER 14
EC( V4 h ' INSPECTION RECORD
ADDRESS '
CITY ` tile%TEL. NO.
LICENSE NO. ���/ ✓
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1,00 $ -
BATH TUB @ $1.00
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1.00 -
KITCHEN SINK @ $1.00 .JQ
DISHWASHER @ $1.00 _
LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER @ $1.00
WATER HEATER @ $1.00
GAS SYSTEM @ $1.00
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING << .f 5(, -4-1 J J,{ ,
O GAS PIPING J
'TOTAL FEE GAS VENT
1 HEREBY ACKNOWLEDGE-THAT I HAVE READ THIS APPLICATION -
AND STATE THAT THE ABOVE IS CORRECT A"ND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING '
PLUMBING. PLU-M'BING FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST `
LICENSED AS REOU��RR•• BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR TrAl- I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIA PROPERTY.
SIGNATURE � L�"�
OF PERMITTEE FINAL IL
JOHN A. LAMB COUNTY ENGINEER V LIDATIO ROBERT A.WOOD. CHIEF PLBG. INSPECTOR
CK. !l.6. CASH
31 i DEC 7 3 2.0 0