HomeMy Public PortalAbout5838 AGNES AVE_Plumbing_6/1/1961_ e r
76AG6�CE817 12/59 TJEMPL - CITY
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND rE}FETY MSION BUILDING /� o `�J ,/ /� Y
JOHN A LAMBI COUNTY NGINEER ADDRESS fir
G ;2 LGhJ /TECO I.{//It�w I
WILLIAM A JENSEN SUPT OF BUILDING
LOCALITY ry
FOR APPLICANT TO FILL IN NEAREST
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NUMBER FIXTURE OR ITEM OWNER
WATER CLOSET MAIL
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ADDRESS -T 3 '/LJfLC/n
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BATH TUB _
SHOWER CITY TEL NS A
LAVATORY CONTRACT8R
SINS ADDRESS
DISHWASHER CITY TEL NO
CONTRACTOR STATE ❑
LAUNDRY TUB REGISTRATIO NO COUNTY ❑
CLOTHES WASHER DISTRICT NO GRO ZONE R>GESBY
WATER HEATER � w v
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
/ /INSPECTION RECORD
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a
$1 00 PER ITEM
13 OR FATURE $ QU APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING �� -1
GAS PIPING
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
PLUMBING HOT WATER HEATER I i
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES J
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST Ip l� � �
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE _
DESCRIBED RESIDENTIAL_,PROPERTY UTILITY CO NOTIFIED 1
SIGNATURE �! /
OF PERMI TE FINAL �I / A"
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76A667 CE�817 6 65 /p
APPLICATION FOR PLUMBING , ERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING (��
JOHN A LAMBIE COUNTY ENGINEER ADDRESS a
COLEMAN W JENKINS SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS Si
NUMBER FIXTURE OR ITEM EACH FEE
OWNER t
WATER CLOSET $125 Z MAIL
BATH TUB 125 ADDRESS
' SHOWER 125 CITY L NO
LAVATORY 125 CONTRACTOR A
SINK 125 ADDRESS
DISHWASHER 125 tCITY TEL NO
STATE LIC
LAUNDRY TUB 125 LICENSE NO CLASS
CLOTHES WASHER 125 DISTRICT NO GROUP ZONE PRO SEED
WATER HEATER 150
I �
GAS SYSTEM OUTLETS 150 INDUSTRIAL a
WASTE APPROVAL O
—I—tOUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD U
'o,
/J — o
CL
APPROVALSAN DATE INSPE OR S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 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 I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSEDAS 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 D RIBED RESIDENTIAL PRO ERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE I ,
FINAL �
LIDATION
CK M O CASH
HALO 1 2 8 7 APR 15 5 D 1125—