HomeMy Public PortalAbout4827AGNES AVE_Plumbing (2) 76A667A
CE 817(REV 11/78)
APPLICATION FOR PLUMBING PERMIT
I
COUNTY OF LOS ANGELES BUILDING AND SAFETY ,
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
ADDRESS
NUMBER FIXTURE OR ITEM ® FEE LOCALITY
WATER CLOSET L OO Temple Cit Unit-8B
NEAREST
1 BATH TUB OO CROSS ST
1 SHOWER OO OWNER Fairhaven Corp.
LAVATORY MAIL
ADDRESS
1 SINK OO CITY TEL NO
DISHWASHER CONTRACTOR Dorsey4 Plumbing CO.
CLOTHES WASHER DQ ADDRESS Bp
SWIMMING POOL RECEPTOR - OO PalOmareS
CITY Le Verne TEL N0599_ 8828
LAWN SPRINKLER SYSTEM
iTATE LIC 1 WATER HEATER OO LIC NSE NO 1 421 C ASS B N0599-OL
6 0.
GAS SYSTEM ,OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE O
V
OUTLETS OVER UNDER SLAB WORK �" —011-1 , C9
5 PER SYSTEM ROUGH PLUMBING cot 1 91 O
GAS PIPING r U
w
GAS VENT fJ N
HOT WATER HEATER z
PLUMBING FIXTURES
GAS TEST _W #y. /Q«�
Plan check fee UTILITYCO NOTIFIED `
PLUMBING PERMIT ISSUING FEE$ OO _ A
TOTAL FEE 4 00 FINAL //. +-�()C •-�-� °^"`
PLAN CHECK VALIDATION
Plan check applicant
Name
Address
City Tel No "
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE I0 0 7,6 A
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION ..µµ
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/Oft LICENSED AS # a 5
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE °
LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL 210 -4300
PROPERTY ,
SIGNATURE t , ' . . . 4 3 005
OF PERM ITTEE
DISTRICT NO
IN + r
Q Q 2 S r$Q
17
DUSTRIAL Gv
WASTE APPROVAL
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