HomeMy Public PortalAbout4931 AGNES AVE_Plumbing_8/24/1972_gas system 76A6671(�,E-817) 8 71
' 4+ r APPLICATION FOR PLUMBING PERMIT
Y� COUNTY OF LOS ANGELES
,DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
r
� LOCALITY -
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM @ FEE OWNER,
WATER CLOSET 1 75 -
MAIL /
BATH TUBL 1 75 ADDRESS
SHOWER 1 75 EL NO
LAVATORY 175 CONTRACTO
4
SINK 1 75 ADDRESS "
DISHWASHER 1 75
CITY TEL N(
CLOTHES WASHER 1 75 STATE -IC ,y
LICENSE NO !!/� CLA y�
SWIMMING POOL RECEPTOR 1 75
�
T GFtO ZONE ROCE BY
LAWN SPRINKLER SYSTEM 1 75
WATER HEATER 1175 m INDUSTRIALT -
WASTE APPROVAL G
GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD V
OUTLETS OVER 30 Q
5 PER SYSTEM
r
V
f W
IL
Vf
Z
Plan check fee I See reverse
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE 7
APPROVALS DATE INSPECTOR 5 SIGNATURE
Plan check applicant UNDER SLAB WORK -
Name ROUGH PLUMBING
Address GAS PIPING
City Tel NO" GAS VENT
I HEREBY ACKNOWLEDGE THAT'I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES C
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED l
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OFA��TO
RESIDE IN THE ABOVE RI ED RES NTIAL P 6FINAL
SIGNATURE
OF PERMIT
PERMIT VALIDATION r
SCK M O t CASH
PLAN CHECK VALIDATION CK M O CASHCQ
1' r
�t7,7 1 3"Co ' AUG 2 4 1 4.7-5-
}
1 �
i t