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7GA687 APPLICATION FOR PLUMBING PERMIT 1
DBS-17 10-55
DIVISION OF BUILDING AND SAFETY
Deportment of County Engineer
County of Los Angeles B U 1 LD I NG /q
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D,GRIFFIN,SUPT OF BUILDING
LOCALITY
FOR APPLIC TO FjjL IN NEAREST
CROSS ST
OWNER ' DISTRICT NO. GRO I Z I READY FOR INSPECTION
MAIL %
ADDRESS (prx
INDUSTRIAL
CIT TEL NO WASTE APPROVAL
PLUMBER INSPECTION RECORD
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ADDRESS
-
CITr1��e�""�/✓f /Y 6 1'//1' I�=
LICENZOee
NUMBER TYPE OF FIXTURE OR ITEM FEE * 2�', ft, 0
WATER CLOSET (TOILET) @ $100 $ I��9'r-7 q1 Mi:5'Ogn ,=,,,r r
BATHTUB @ $1.00 PAM
SHOWER @ $1.00
LAVATORY (WASHBASIN) @ $100
KITCHEN SINK @ $1.00
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $100
CLOTHES WASHER @ $100
WATER HEATER @ $100
GAS SYSTE @ $100
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK'
PERMIT $ 1 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE ,,�
GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AM PR LY REGISTERED,AND/OR GAS TEST
LICENSED AS REQUIRED BY S A LES COUNTY AND STATE OF
CALIFORNIA OR THAT I A T LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED
DESCRIBED RESIDENTIAL OP TY.
SIGNATURE
OF PERMITTEE FINAL
��� Z 17-
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
M
CK O. ASH
LCO 3 0 3'7Lno DEC ' 5 3 2.0 0 m