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�'DEPARTIVII:N'll OF COUNTY ENGxNEER
' DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM Ja.FOX, COUNTY ENGINEER ;.ADDRESS
FOR APPLICANT TO FILL IN LocaLlrY i ,
J�� OSS ST.
NEAREST
ADDRESS CR DISTRICT N0. GROUP LQONE PERM
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LOCALITY J/ I CJI
NEAREST
CROSSST. BEGS VED.B//' Roady for Ineoeetlon TE ISSU DD`
OWNER o.Y �� �E CZE
MAIL rNDUSTRIA-C'
ADDRESS WASTE APP OVAL
CITY TEL.No. INSPECTION RECORD
RPLUMBE )Cn -s T / N,)7 c=
ADORESSGQ D/ ID
CITY96:'r4/'/v/Y TC-' TEL N0.
87632-leZ& -Se,7.m Ll OU T
LICENSE N0Y
J '
PERMIT FEES z
4UMSER TYPE OF FIXTURE OR ITEM FEE n
WATER CLOSET(TOILET) @ 0.80 iO
13
BATH TUB @ 0.80 110
SHOWER @ 0.80
—TLAVATORY(WASH BASIN) @ 0.80 2f D
-1 KITCHEN SINK 0 0.80 IB o
LAUNDRY TUB OR TRAY 0.80
SLOP SINK 0.80
FLOOR SINK 0.80
FLOOR DRAIN 0.80
DISHWASHER 0 -0.80
DRINKING FOUNTAIN G 0.80
URINAL W 0.80
GAS SYSTEM...27.-OUTLETS 8f 1.00 0
WATERHEATER @ 1.00 0
MISCELLANEOUS
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK A i
PERMIT $ I 1 00 ROUGH PLUMBING
TOTAL FEE GAS PIPING l
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- GAB VENT �> to f!
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE NOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES yq/ a
AND OR RREBY LI ENSED IAS R QUIRTHAT ED AN PROPERLY
EAN ANGELES COUNTY OAS TEST C NNW
�u
ER OFTHEABOTE CALIFORNIA RIBED R HAT I D NTM THE
PROPERLEGAL
Y OWN- UTILITY CO.NOTIFIED p�
SIGNATURE
OF PERMITTEE - -.......�.. _.
FINAL /
76A667 DBS 17 a b 12-53 `