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DBS 17 IAPPLICATION FOR PLUMBING PERMIT 1
D BION OF BUMDMG AND SAFETY
DeparbaAmt of Coaatp Engl ager
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JOHN A LAMBIE COUNTY ENGINEER
CASSATT D GRIFFIN SUP T OF BUILDING �
LOCALITY
FMAIL
OR APPLICANT TO FILL IN NEAREST
CROSS ST
DISTRICT N GROUP ZONE I READY FOR INSPECTION
�O
INDUSTRIAL
CITY TEL NO -S2WASTE APPROVAL
PLUMBER 1 II�TSPECTION RECORD
ADDRESS J �Iof XLn�ve
CI /.7�3 6 p TELNO
V,6--3
LICENSE NO f/
NUMBER TYPE OF FIXTURE OR ITEM FEE
2, WATER CLOSET(TOILET) @ SI 00 S
I BATH TUB (� s1 00
SHOWER @ $100
oZ LAVATORY (WASH BASIN) @ $100
/ KITCHEN SINK @ $100
/ DISHWASHER @ $100
LAUNDRY TUB OR TRAY @ s1 00
CLOTHES WASHER @ $100
I WATER HEATER @ $1 00
GAS SYSTEM @ *too
APPROVALS
DATE INSPECTOR S SIGNATURE
UNDER SLAB WORK -alc
PERMIT $ 1 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE 06 GAS VENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .41
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING PLUMBING FIXTURES
1 HEREBY CERTIFY THAT I 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 r
DESCRIBED RESIDENTIAL ROPERTY
SIGNATURE
OF PERMITTEE FINAL / yj
JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CS M 0 CASH
"I AD i 9 9864, Am 15 3 12.00 2
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