HomeMy Public PortalAbout5218 AGNES AVE_Plumbing_0 76A667 CE#617 5/63 �
APPLICATION FOR PLUMBI G PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
WILLIAM A JENSEN Sup !OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE ,(J
OWNER
WATER CLOSET $1 25 MAIL
BATH TUB 125 ADDRESS b �-
SHOWER 125 CITY TEL NO
LAVATORY 125 CONTRACTO
Ajlj SINK 125 ADDRESS dx,
DISHWASHER 1 25 CITY 64
TEL NO _
LAUNDRY TUB 125 CONTRACTO STATE
REGISTRATION NO �r COUNTY ❑
CLOTHES WASHER 125 DISTRICT NO GROUP NE OC EP Y
WATER HEATER 1 50 �`
GAS SYSTEM OUTLETS 150 INDUSTRIAL d
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM 30 U
INSPECTION RECORD
*44 aeW 'A 1441f
✓` S N
Z
APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
` ROUGH PLUMBING
TOTAL FEE Ll ` GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING HOT WATER HEATER
I HEREBY CERTIFY THAT I 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 AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED REST ENTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL
M,,,�DATION
ROBERTA WOOD
o cnsH SUPERVISING MECHANICAL ENG R
LAW 4 2 9� OCT 14 5 D 4.50- Iq