HomeMy Public PortalAbout4829AGNES AVE_Plumbing (3) CE 817 IREV 6/78)Os
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;., • APPLICkATtON FOR PLUMBING PERMIT '
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COUNTY OF LOS ANGELES e > RUILDING,AND SAFETY , -
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' FOR APPLICANT TO FILL IN(PRINT OR TYPE(` 1 BUILDING
ADDRESS'482 ,
NUMBER "FIXTURE OR ITEM ® FEE
LOCALITY Tem le City Uniti -5A .{ ra
WATER CLOSET+ „
NEAREST /J °
BATH TUB _ 00 CROSS ST' G
SHOWER - OWNER �lr V n +
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LAVATORYRQ , ADDRESS
a, (SINK ! { a CITY, • r, TEL NO
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DISHWASHER +
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._ CONTRACTOR, ^DOTS@ Plumbin .' a
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CLOTHES WASHER 31 00 ADDRESS800 Pal nmeres
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SWIMMING POOL RECEPTOR L "� `
Y LAWN SPRINKLER SYSTEM , CITY La Verne � ,`TEL NO _082
{ STATE f ,; LIC
WATER HEATER `< LICENSE NO ' i r" CLASS'w ' `
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GAS SYSTEM OUTLETS QO " APPROVALS,' DATE ' SPECTOR S SIGNATURE
OUTLETS
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OUTLETS OVER . UNDER SLAB WORK
5'PER SYSTEM ROUGH PLUMBINGo
+ ''�q�,�
' GAS PIPING 'iU ` O
GAS VENT
<� r Q HOT WATER HEATER ,
' PLUMBING FIXTURES. ' + A" � 9
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16—g-gj) 66
,Plan check fee UTILITY CO NOTIFIED J a
PLUMBING PERMIT ISSUING FEE$
FINAL 'y P ' r
" TOTAL FEE 43100 .
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• PLAN CHECK VALIDATION
Plan check applicant '
Name - ,
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Address , , L
City 1 y Tel No
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES • ' "' r
AND STATE LAWS REGULATING PLUMBING + PERMIT VALIDATION I 1 0"+'"' ",A
y,I HEREBY CERTIFY THAT I AM PROPERLY REGISTEREWAND/ORI LICENSED AS { ' • Pa ° # • • * 065
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 « 1 + 3 O O
PROPERTY - , 6 . 4[
'SIGNATURE j ti ° ' ' '°8 • • 4 3,v 0 its+
OFIRERMITTEE
DISTRICT NO PROCESSED BY '`r a 0,4,28-18,0
'INDUSTRIAL I
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WASTE APPROVAL
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