HomeMy Public PortalAbout5923 AGNES AVE_Plumbing__ 76A667 CE9817 6 65
APPLICATION FOR PLUMBIN PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
y2 a3
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH EEl
OWNER
WATER CLOSET 31 25 MAIL
1 BATH TUB 125 ADDRESS
SHOWER 125 CITY TIV NO
y LAVATORY 125 CONTRACTOR
1 SINS 12S ADDRESS C
DISHWASHER 125 CITY U TEL NO no
STATE - LIC
LAUNDRY fUB 125 LICENSE NO3 7 CLASS C-13-4
CLOTHES WASHER 1 1 25 DIS�ICT klimlGR E P CE BY
WATER HEATER ( 1 50 O 7 Z
GAS SYSTEM OUTLETS 1 50 INDUSTRIAL O
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD V
a
O
H
V
W
C
N
Z
APPROVAY9 DATE INSPECT0jt SSIGNATURE
PERMIT S 2 00 UNDER SLAB WORK /-/Z-y
ROUGH PLUMBING --
TOTAL FEE H 12,5GAS PIPING
s �
I 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 HOT WATER HEATER
PLUMBING
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 AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE 6CRI ESIDENTIAL P ERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL l �wf '-
�ALIDATION
CK M O CASH
Lid -4 o o 11-0 ijm 2 2 5 D 1 125-
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