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PLUMBING 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
OOUNTY OF LOS ANOM BUILDING
WILLIAM L FOX. COUNTY ENGINEER ADDRESS 'yD
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS SERO CROSS ST
DISTRICT NO CRWUR- IONS P 'r No
LOCALITY 1 �� L I p -/ (/(J_ G
NEAREST
CROSS OT �T //--�� R CEIVED V Reedy for lornatlon DATE ISSUED
A
OWNER 'L-, C //(J(y/
MAIL INDUSTRIAL
ADDRESS WASTE APPROVAL
CITY TEL NO INSPECTION RECORD
PLUMBER )D. 57'Ltg A+ 4~ �1 ,I
ADDRESS !7 l O
CITY L Ma Ai* TEL NO "Io /rT9
(, n n ATE
LICENSE NO a / 0 IggOUNTY
J
PERMIT FEES <
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411M0[P T rx Or FJXrUR[ OR MM R[ 0
WATER CLOSET(TOILET) 0 080 S
BATHTUB ® 080 0
SHOWER ® 080
LAVATORY (WASH BASIN) 0 060
U
KITCHEN BINK 0 080 r)
LAUNDRY TUB OR TRAY 0 080 0
MOP BINK 0 080
FLOOR$INK @ 0 S
FLOOR DRAIN 0 080
DISHWASHER 0 080
DRINKING FOUNTAIN 0 OSO
URINAL 0 Goo
GASSYSTEM _OUTLETS 0 Ido O
WATER NEATER 0 100 as
MISCELLANEOUS T
APPROVALS
DATE INSPECTOR'$SIGNATURE
1 UNDER BLAB WORK
PERMIT s 1 00 ROUGH PLUMBING
TOTAL FEE O a GASPIPINO
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ T IS APPLI• GASVENT
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE HOT WATER HEATER' C/
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATIM9 PLUMBING PLUMBING FIXTURES / A
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAB TEST
AND STATE OF CALIFORNIA OR THAT 1 AN THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDpENTIAL PROPERTY UTILITY DO NOTIFIED S
SIGNATURE / 71
OF PERMITTEE C _ _ ___ __ __ _
FINAL
TOASBT DRS 17 rAA 1e_41