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DAPPLICATION FOR PLUMBING PERMIT
B6 IT' DIVISION OF BUWMG AND SAFETY
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COmt! Of LOB AnOR BUILDING G C
WM J FOX, COUNTY ENGINBDIR BUILDING14
CASSATT D GRIPPIN. SUP T OF BUMOINO ADDRIESS
fent PLI• LOCALITY
FOR APTOAMI IN NEAREST
CROSS JET
OWNER DISTRICT N OROVP ZONE tEAOr roR IRC PECTION
MAIL / /
ADDRESS
INDUSTRIAL
WAST!APPROVAL
=:t�PLUMBER I INSPECTION RECORD
ADDRESS
CITY TEL NO
LICENSE NO
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) s
BATH TUB _
SHOWER
LAVATORY (WASH BASIN) }
KITCHEN SINK 11r- /
DISHWASHRR T J1 F
LAUNDRY TUB OR TRAY_ YJ fyzr
CLOTHES WASHER /, i CT
T TAL N a 0 BO APPROVALS
GATE INSPESTOR f SIGNATURE
OAS SYSTEM OUTLlTS6 100
UNDER BLAB WORK
WATER HEATER 1 00
ROUGH PLUMBING
PERMIT • 00 OAS PIPING
TOTAL FEE GAS VENT
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AMD/OR AS TEST
LICENSEDAS REOUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO NOTIFIED
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER 0 TH ABOVE
DESCRIBED RESIDENTIAL PROPERTY \
SIGNATURE (^_
OFPERMITTEE RINAL Y--a O'
WILLIAM J FOX,COUNTY ENGINKER VALIDATION
ICp1 5 4 3In K014 3 4.00
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