HomeMy Public PortalAbout5120 AGNES AVE_Plumbing_5/5/1969_gas system, outlet 76A667—CE 817468 �—
APPLICATION FOR PLUMBINGRMIT �)
COUNTY OF LOS ANGELES u
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING /
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE Oft
OWNER
WATER CLOSET 1 50
BATH TUB 1 50 ADD SS 1.20 121
SHOWER 1 50 CITY TEL NO
LAVATORY 1 50 CONTRACTOR �-+--
SINK 1 50 ADDRESS 0 Zf k
DISHWASHER 1 50 CI1Y 4 TEL NO ^�jZ�/ 4
CLOTHES WASHER 1 50 STATE LIC n
LICENSE NO CLASS Ga
SWIMMING POOL RECEPTOR 150 DISTRICT NO GROUP ZONE I PROCESSED BY
LAWN SPRINKLER SYSTEM 2 000'
WATER HEATER 1 50 INDUSTRIAL E)
WASTE APPROVAL
lGAS SYSTEM OUTLETS 1 50 rp INSPECTION RECORD O
OUTLETS OVER
5 PER SYSTEM 30 —
W
a
Z
Plan check fee 25% of above See reverse
PLUMBING PERMIT ISSUING FEE 8 2 00
TOTAL FEE APPROVALS DATE INSPECTOR 5 SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City Tel NO HOT WATER HEATER
IH
ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED i
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE GAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DEGC IB RES NTIA ROPERTY FINAL
SIGNATURE JACK R ALLEN SUPERVISING MECHANICA NG
OF PERMITTEE
PERMIT VALIDATION CK M o CASH
PLAN CHECK VALIDATION CK M o CASH
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