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APPLICATION FOR PERMT
• DEPARTMENT OF MWING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING 1
WILLIAM J FOX CHIEF ENGINEER I
FOR APPLICANT TO FILL IN DISTRICT NO GROUP ZONE PERMIT NO
PLUMBER -4l♦��-'�rfw./� �'J� REC[V[D BY READY FOR DAT[I¢8U¢D
ADDRESS `� V /I� �� • gq�trf FIRST INSPECTION _„_ ,�Y
BUILDING `
CITY TEL NO ADDRESS
COUNTY F 91
_ �T LOCALITYLICENSENO' d KXPIR e� LO
NEARWT
PERM Imp CR088
MYM�[R TYPE OFLIAI
PERM
OLR�I.WMM FEE OWNER
MAIL
WATER CLOBET TOILET a O SO ADDRESS
BATHTUB 050 CITY TEL NO
SHOWER O to 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY WASH BASIN o . V APPLICATION AND STATE THAT THE ABOVE 18 CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE LAWS REGULATING PLUMBING
KITCHEN BINK O SO 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOB
LAUNDRYTUB RTRAY O SO ANGELES COUNTY ICENS¢ OR 1 AM THE "CAL OWNER
OF THE RESIDENTI PROPERTY DESCRIBED ABOVE
GAS BY BT6 OVTLETB a O SO SO • /•I (JSP'+
SIGNATURE OF (a I
WATER HEATER O SO P[RMITT[
SLOPSINK O SO SPEIMON RECORD
FLOOR BINK O SO
FLOOR DRAIN O SO
DISHWASHER O SO
DRINKING FOUNTAIN O SO
URINAL O SO J
a
House e[w[R o so Z
MISCELLANEOUS V
O
APPROVALS
DATE INPPKCTOR• HAM[
ROUGH PLUMBING
GAB PIPING
GAS VENT
CESSPOOL 100 CESSPOOL
SEPTIC TANK SEPTIC TANK
DRAIN 1 ) PIT I I ® 100 SEWER
PERMIT 1 00 GAB TEST
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UTILITY CO NOTIFIED
TOTAL FEE Y Q
3 � FINAL I(