HomeMy Public PortalAbout4829AGNES AVE_Plumbing (2) } I , L
76A667A , ' 7 ` ir'
CEO 17(REV 8/78)
• APPLICATION FOR PLUM B ING'PERM IT ' • • .' y
COUNTYOFLOS ANGELES , • BUILDING AND SAFETY
FOR,APPLICANT TC FILL'IN(PRINT OR TYPE) `� `BUILDING` '
' ADDRESS 4829 T^••^•^ n viii_OR z
NUMBER FIXTURE OR,ITEM' ® FEE
WATERrCLOSET r ' , •� LOCALITY, Tem le CltV Unit-4B'
' NEAREST I
r BATH TUB ' " oo CROSS ST •5 '
SHOWER to 3 OO 'OWNER Fairhaven Co
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S`7� LAVATORY • ` 9 OO,`ADDRESS x
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SINK ° f, • Al no CITY` 7 TEL NO
' DISHWASHER 'CONTRACTOR
iorsey Plumbin ,Co.
CLOTHES WASHER , ,00 ADDRESS`
SWIMMING POOL RECEPTOR
CITY Tag Vprnp `TEL NO
LAWN SPRINKLER SYSTEM . STATE LIC15,99
{' WATER HEATER 00 LICENSE NO 315421 CLASS„ B C- 6
1 GAS SYSTEM- ° OUTLETS F 31 00 APPROVALS DATE !.NSJECTOR S SIGNATURE °
OUTLETS OVER!, - UNDER SLAB WORK•
5PER SYSTEM ROUGH'PLUMBING ,{a -
L}'� GAS PIPING „O
f,f. GAS VENT
'+ HOT'WATER HEATER '
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� 'PLUMBING FIXTURES
• �' ; ' GAS TEST .'1/
'Plan check fee UT,ILITYCO NOTIFIED- f Z
t , PLUMBING PERMIT ISSUING FEE$ OO ,
t TOTAL FEE FINAL'
PLAN CHECK VALIDATION
Plan check applicant a ,,
Name
Address r
City, Tel No n
'I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT . O 0810 A e
• THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES ' ° ' ' `
AND STATE LAWS REGULATING PLUMBING PERMIT VAUDATION', #.• • • • 5
I HEREBY,CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE ' ` 20•!• 43-0 0
LEGAL OWNER OF AND°INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL ' _ '
PROPERTY I
e SIGNATURE ' _ I
04,,28, 80
OF PERMITTE• ` 4 „ ' S�
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DISTRICT�� � P96CESSED
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INDUSTRIAL t '
'WASTE APPROVAL