HomeMy Public PortalAbout4827AGNES AVE_Plumbing 76A667A
CE 817(REV 11/78)
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APPLICATION FOR PLUMBING PERMIT ,
COUNTY OF LOS ANGELES _ BUILDING AND SAFETY '
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
ADDRESS �$ a
NUMBER FIXTURE OR ITEM ® FEE
WATER CLOSET LOCALITY T m `1 iti U t—
NEAREST g
1 BATH TUB 00 CROSS ST -
1 SHOWER 3 00 1
OWNER Fairhaven Co
LAVATORYMAIL
ADDRESS
1 SINK 3 00 CITY + 1 TEL NO
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DISHWASHER CONTRACTOR Dorsey Plumbing Co.
1 CLOTHES WASHER t 00 ADDRESS
800 PaTomprgs
SWIMMING POOL RECEPTOR '
CITY Le Verne TEL NO 59 -0828
LAWN SPRINKLER SYSTEM JATE LIC
1 WATER HEATER 00 LIC NSE NO 315421 CLASS B C-36
1 GAS SYSTEM OUTLETS 3 00 APPROVALS DATE INSPECTOR S SIGNATURE U
OUTLETS OVER UNDER SLAB WORK ° -Fy '
5 PER SYSTEM ROUGH PLUMBING _ Q
GAS PIPINGS t.. u
' GAS VENT N
HOT WATER HEATER F
PLUMBING FIXTURES
GAS TEST ,%I om
Plan check fee UTILITY CO NOTIFIED
PLUMBING PERMIT ISSUING FEE$ 00
TOTAL FEE 143 100 FINAL
Plan check applicant PLAN CHECK VALIDATION U °
Name
h _
Address
City Tel No
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE A 0 07.5 A
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION # • • 5
t
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS Z 0
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE 4 3
LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY t. `� A a 0 0 Z
SIGNATURE �y �] p Q vO
OF PERMITTEE OkG CJ
DISTRICT NO PROCESSED Y ,
INDUSTRIAL
WASTE APPROVAL