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13119-173:s8 APP'LI'CATION FOR PLl9MBI. SIG_ PERMIT 1
.i
DMSION OF RUILDING .AND SAFETY
Department of COunty Englueer
COnnty of LOS AngeleB BUILDING
WM.J. FOX. COUNTY ENGINEER ADDRESS r/W f��/ ted"'�++i! �•Y^
CASSATT D.GRIFFIN.SUP"T OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN CROSS RE •- A
OWNER (A c, '/Y DISTRICT NO, GROUP ONE EAUY Rox.imspicTiou
MAIL. I
ADDRESS
INDUSTRIAL
CITY j�"� TEL.NO: WASTEAPPROYAL___
PLUMBER A:DIY�AN,�r+vv f)/�CI INSPECTION RECORD
ADDRESS .219
�J /�� V/ .. ✓ �GJAI {S /' a
CITY
LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET)
BATH TUB..
SHOWER
LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER.
LAUNDRY TUB OR TRAY-
CLOTHES WASHER
TOTAL NO. 0. O.eo APPROVALS
DATE INSPECTOR`S SIGNAIURE.
GAS SYSTEM 6� OUTLETS 1.00 O
WATER HEATER AI 1.00 0.0 UNDER SLAB WORK t
ROUGH PLUMBING
PERMIT $ T 00 GAS PIPING
TOTAL FEE 9047 GA'S•V.ENT
1 HVKEBY ACKNOWLEDGE THAT 1 RAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ,y
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING .. PLUMBING FIXTURES
PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED•AND/OR GAS TEST i
LICENSED AS REQUIRED BY LOS ANGELESCOUNTY AND STATE-.OF UTILITY CO.NOTIFIED
CALIFORNIA OR THAT 1. AM THE LEGAL. OWNER OF THE. ABOVE
DESCRIBED RESIDENTI L PH PERTY.
SIGNATURE
OF PERM17 Fer
.4•"Y*..' r''af ''�'' 4f'' •"'` "r �•
WILLIAM J.FOX.COUNTY ENGINEER VALID ^
R.A.WOOD.CHIEF FLBta).INSPECTOR
LAO
I If% 6 1 9 .' PLAY-153 3 11 .00
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