HomeMy Public PortalAbout4946 AGNES AVE_Plumbing_0 76A667 CE817 6 60
APPLICATION FOR PLUMBING PERMI �
COUNTY OF
CUNENINEER
BUILDING AND SAFETY DIVISION BUILDING '
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
WILLIAM A JENSEN SUP T OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST ,
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET MAIL
BATH TUB ADDRESS
CITY TEL NO
SHOWER
CONTRACTO
LAVATORY
SINK ADDRESS
DISHWASHER CITY TEL NO _S3
&RASTATE
LAUNDRY TUB REGISTRATION NO j COUNTY
CLOTHES WASHER DISTRICT NGROU117
O BY
WATER HEATER
1
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
0-1,4"14H
1 AL a'ti �+e P��! ^� P.
C01
17-0 agr M-ad -09C 0 0
O
. f w
a
0 $1 CO PER ITEM �
OR FIXTURE $ 3t "(�0 APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE .A� ROUGH PLUMBING
GAS PIPING G/
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE p
DESCRIBED RE3IDENTIA PROPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTE
INAL e 1 e, #4-- j/
OF 7,C6
N ROBERT A WOOD
C"H SUPERVISING MECHANICAL ENG R
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