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DEPARTAMNT OF COUNTY ENOIIYEEK PLUMBING 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
OOUNTY OF Log ANGELES SUI LDING ys,
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS
FOR APPLICANT TO FILL IN LOCALITY i
BUILDING NEAgEBT
ADDRESS A CRon ST
LOCALITY
DISTRICT NO GROUP ZONE PERMIT NO
F G 1 S
CROS
S ST
o'ADwM
RECEIVED B]6 RgOY fr lO.neGoe OAT ISS ED
OWNER � � (Q6FL�T/d.cK.7
3
MAIL INDUSTRI
ADDRESS SQ/../ WASTE AP VAL
CITY TEL NO INSPECTION RECORD
PLUMBER
ADDRESS
CITY TELpM,O �7 STATE�G
LICENSE NO 0 0 COUNTY
J
PERMIT FEES =
VIIME[p TYPL OF FIXTURE OR ITEM F[[
WATER CLOSET(TOILET) 0 an F C
BATHTUB 0 060 O
SHOWER 0 090
LAVATORY(WASH BASIN) 0 060
KITCHEN SINK 060
LAUNDRY TUB OR TRAY 0S0
SLOP SINK ® 0 SO
FLOORSINK 0 0110
FLOOR DRAIN 0 000
015RWASHER 0 0 SO
DRINKING FOUNTAIN 0 0 SS
URINAL 0 080
GASSYSTEM _ _OUTLETS 0 100
WATER HEATER 0 100
MISCELLANEOUS
AO APPROVALS
,DATE INSPECTOR'S SIGNATURE
UNDERSLABWORK
PERMIT s I 00 ROUGH PLUMBING
TOTAL FEE Z 00 GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS 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
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LO ANGELES COUNTY OAS TEST
AND STATE OF
REQUIRED
OWN.
ER OF THE ABOVE CALIFORNIAIF PERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE _ ___._
FINAL
76A667 DBB 17 1/5f r