HomeMy Public PortalAbout5002 AGNES AVE_Plumbing_0 "6A667 CE#'817 2 62
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
WILLIAM A JENSEN SUP T OF BUILDING
LOCALITY �
FOR APPLICANT TO FILL IN NEAREST
OSE ST CI
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $125 SQ
MAIL
BATH TUB 125 ADDRESS
SHOWER 125 2 CITY TEL NO
Z LAVATORY 125 5-O 'CONTRACTOR (24
SINK 125ADDRESS
DISHWASHER 1 25 CITY TEL NO 7 S
LAUNDRY rUB125 �CONTRACTOA STATE
REGISTRATION NO COUNTY ❑
CLOTHES WASHER 1 25 2 DISTRICT NO GR UP Z NE P ESSED BY
WATER HEATER 1 50
GAS SYSTEM L§ OUTLETS 1 505Q INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD a
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PERMIT $ 2 00 UNDER St*B-WORK
ROUGH PLUMBING Y
TOTAL FEE a Q Q GAS PIPING v !
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER ` v
PLUMBING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES VY _
LICENSED AS REQUIRED LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AMM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED a
SIGNATURE
OF PERMITTEE
FINAL
VALIDATION ROBERT A WOOD
cK M o CASH SUPERVISING MECHANICAL ENG R
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