HomeMy Public PortalAbout5928 AGNES AVE_Plumbing__ 76A667C ICE-817B) -9 75
APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
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FOR APPLICANT TO FILL IN (PRINT OR TYPE) ADDRESS W /O�i/) GVII�/�� �1 NUMBER FIXTURE OR ITEM @ FEE
WATER CLOSET U LOCALITY�,X: 4C 6`'i'1
BATH TUB NEAREST (�
U (J CROSS ST. ,L Ck
SHOWERo OWNER
LAVATORY MAIL
ADDRESS
f SINK CITY TEL. NO.
DISHWASHER CONTRACTOR
CLOTHES WASHER
SWIMMING POOL RECEPTOR ADDRESS ' �G ^�C 7-/V 61
LAWN SPRINKLER SYSTEM CIT ��� Jlj��[? TEL. NO.&,,,�-12
STATE
WATER HEATER L CENSE NO. Tr✓� CILASS lam „
DISTRICT NO. GROUP 20NE P OCE D BY
U
` GAS_SYSTEM OUTLETS — k�
OUTLETS OVER U
5 PER SYSTEM INDUSTRIAL a
WASTE APPROVAL
1 NSPEC TI ON REC ORD
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Plan check fee
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
Plan check applicant
Name APPROVALS DATE INSPEC-TjOR'S SIGNATURE
UNDER SLAB WORK 12--ZZ- ffh_
Address ROUGH PLUMBING v�
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Tel. No. GAS PIPING ` �REBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENTTE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYLL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATERaiR E"G.REBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURESD AS REQUIRED BY OSANGELESCOUNTY AND STATE OF GAS TESTNIA ORTHATIAHELEGALOWNER OF, AND INTEND TO 75 7vN THE ABOVE DES (BED RESIDENTIAL PRO RTY. UTILITY CO. NOTIFIED ®� �� it,F,c,1'i,_,U RE / �"ERMIT FINAL 3' �7 71
PLAN CHECK VALIDATION CK. M. CASH P ITj�ALIDJAT[PN 6
85 .� 'l f