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•1771R•84 APPLICATION FOR PLUMBING PERMIT
S
DMSION OF BUILDING AND SAFETY
�F ► Deportment of County Engineer
County Of Los Angeles BUILDING
WM.J.FOX, COUNTY ENGINEER ADDRESS.
CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALIT ` I 57
.
FOR APPLICTO FILL IN NEARS TY
ANT
CROSS ST. L oCC/L�
OWNER .- DIST T NO.
MAIL I GROUP eUP i ZQNE READY FOR INSPECTION
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ADDRESS
^ INDUSTRIAL
CITY C TEL.NO. WASTE APPROVAL
ell7AS _ 'INSPECTION RECORD
t '
ADDRESS
CITY C TEL. NO.
LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET)
BATH TUB
SHOWER
LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER
TOTAL NO. 0.80 APPROVALS
DATE INSPECTOR'S SIGNATURE
GAS SYSTEM CUTLETS � 7,00 A10.90217.4--le UNDER SLAB WORK .1 .021 +
WATER HEATER (gl 1.00
ROUGH PLUMBING
PERMIT S 1 00_ GAS PIPING
TOTAL FEE C!' GAS VENT r
[DESCRIBED
HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION +HOT WATER HEATER
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
MBING. p
HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND OR GAS TEST
NSED AS REQUIRED BY LOS ANG C NT AN S F UTILITY CO. NOTIFIED
FORNIA OR THAT l AM THE . L E O T OV
RESIDENTIAL PROPER
IGNATURE
PERMITTEE FINAL
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION
NOV 3 .
BY
' EPUTY .
7 , w
76A667-CE0817 2-56
APPLICATION FOR PLUM ING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 7 O
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS Qat G�
COLEMAN W. JENKINS. SUPT. OF BUILDING LO 1SY p
FOR APPLICANT TO FILL IN NEARESTCROSS .
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSES $1.25
MAIL
BATH TUB 1.25 ADDRE 49--v?
SHOWER 1.25 _ C _ —�
_ LAVATORY 1.25
CO TO tl G
SINK 1.25 ADD0-1
o
RESS 0 O
DISHWASHER 1.25 TEL. NO.
LAUNDRY TUB 1.25 STATE LIC
LICENSE NO. c�Z/� CLASS
CLOTHES WASHER 1.25 DcJ ICT NO GrP Z E P CE BY
WATER HEATER 1.50 67 1
GAS SYSTEM OUTLETS 1.50 WASTEINDUSRLAL c
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .80 INSPECTION RECORD v
O
v
W
D..
y
Z
APPROVALS DATE. INSPECTOR'S SIGNATURE
` - PERMIT -S 2 ' 00 UNDER SLAB WORK _
ROUGH PLUMBING
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY `
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER _
1 HEREBY CERI'IF AM PROPERLY REGISTERED AND/OR MBING FIXTURES
LICENSED AS R IRED BY LO NGELES COUNTY AND STATE O GAS EST
CALIFORNIA THAT 1 AM THE GAWNER OF,AND INTEND .
RESIDE IN, E ABOVE D @ . SIDE TIAL PROPERTY. UTi ITY CO.NOTIFIED
SIGNAT E
OF PER TT
NAL
/--XMMATION JACK R. LLEN
/`C✓K..I M.0. CASH SUPERVISING MECHANICAL ENG'R.
L -0AC .9 8 5 5 SULK$ 5 D 3.50^'