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DEPARTMENT OF COUNTY ENGENEER L U I G I
DIVISION OF BUILDING AND SAFETY PERMIT APPLOCAVION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS
FOR APPLICA T TO FILL IN LOCALITY _ G
BUILDING �p/.,� NEAREST
ADDRESS ��77 CROSS ST.
DISTRICT N0. GROUP 20NE PERMIT NO.
oLOCALITY00,
NEAREST ry �•
CROSS ST. / - /(� /�/g� RECEIVED BY Ready for Inspection DATE ISSUED
OWNER /4 Sri/�• /"/ ����
MAIL INDUSTRIAL
ADDRESS � — WASTE APPROVAL
CITY c�GNo. INSPECTION RECORD
PLUMBER �I�.�r (�[/y ot/ 0 t" a., it/•r� r� i - " ne/, '
ADDRESS % ����•"^
CITY TEL.Ngggx �A
❑sT
LICENSE NO. OUNTY
PERMIT FEES Z'° OAA lA64rg _-1 "` G torr 201
T
NUMBER TYPE OF FIXTURE OR ITEM FEE
L7
WATER CLOSET(TOILET) @ 0.80 $ E
O
BATH TUB c- ' @ 0.80
SHOWER Bk-� 4CPW, @ 0.80
LAVATORY(WASH BASIN) @ 0.80
KITCHEN SINK @ 0.80
LAUNDRY TUB OR TRAY @ 0.80
SLOPSINK @ 0.80
FLOOR SINK @ 0.80
FLOOR DRAIN @ 0.80
DISHWASHER @ 0.80
DRINKING FOUNTAIN @ 0.80
URINAL @ 0.80
GAS SYSTEM..._.•......_OUTLETS @ 1.00
WATER HEATER @ 1.00
MISCELLANEOUS
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ TN S APPLI- GAS VENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES
i HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY i GAS TEST
AND STATE OF CALIFORNIA OR TH T I AM THE LEGAL OWN-
ER OF THE AB DESCRIBED R DENTIAL PROPERTY. UTILITY CO.NOTIFIED
81GNATURE f _ `j /
OF PERMITTEE..... .•_•. ..---_!_ .•.. ..-•_... •._•.. ....•...•.•. FINAL l�/
WRIN
76A667 DBS 17/03