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COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department of County Engineer Alft
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer
ISTRI:CT N.O. GROUP ZONE .
FOR APPLICANT TO FILL IN wo�
PLUMBER ( I.I ry PolII PVAPD P1 IIIA INRECEIVED BY READY FOR DATE ISSUED
•- - - - - FIRST INSPECTION
ADDRESS -ZCT VAI I Fy Rl BUILDING
J /7
n�7q ADDRESS
CITY f" L TENo. AT. Z'c/1 COUNTY -
LICENSE NO. EXPIRES 6-30' LOCALITY
NEAREST
PERMIT FEES CROSS ST. _
NUMBER - TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET(TOILET) 0.50 ADDRESS
BATHTUB 0.50. - CITY TEL. NO.
SHOWER 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS 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 I AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED AB VE.
GAS SYSTEM-OUTLETS @ 0.50
SIGNATURE OF
WATER HEATER 0.50 PERMITTE
SLOP SINK. Q 13.50 INSPECTION RECORD
FLOOR SINK @ 0.60
FLOOR DRAIN 0.50 " evG��`� '
DISHWASHER 0.50
DRINKING FOUNTAIN 0.50 -
URINAL @ O.SO -J
Q
HOUSE SEWER @ 0.513 Z
MISCELLANEOUS '- 17
O
APPROVALS
DATE INSP•50TOR's9 NAME
ROUGH PLUMBING
—
13AS PIPING -
i GAS VENT { dd
CESSPOOL @ 1.00 CESSPOOL { _
a r
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 SEWER If V I e
PERMIT . . . . . . 1.00 GAS TEST I , 1QSob S
UTILITY CO.NOTIFIED �la9i
TOTAL FEE
JA�7
I v`
FINAL
76AG67 DBS##17 6-52