HomeMy Public PortalAbout4831AGNES AVE_Plumbing (3) C
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CE 817(REV 11/78)
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
I FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
ADDRESS 4831 Lsi*Q£
NUMBER FIXTURE OR ITEM ® FEE
LOCALITY �
2 WATER CLOSET r
NEAREST
1 BATH TUB 300 + CROSS ST
1 SHOWER 300 OWNER Fairhaven CO .
MAIL
LAVATORY
2 , 6 00 ADDRESS
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1 SINK 3 00 CITY a' TEL NO
DISHWASHER CONTRACTOR Doisey Plumbing Co.
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR
CITY La Varnp TEL NO _
LAWN SPRINKLER SYSTEM STATE LIC -
WATER HEATER 1 LICENSE NO 315421 CLASS B C-36 a
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE 0
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OUTLETS OVER UNDER SLAB WORK19
5 PER SYSTEM ROUGH PLUMBING .-2_.-Pb 0
GAS PIPING ) W
GAS VENT ..- d
HOT WATER HEATER Jf NZ
PLUMBING FIXTURES
+ GAS TEST -�/� .��•.__,.
Plan check fee UTILITY CO NOTIFIED C
PLUMBING PERMIT ISSUING FEE$ ` 00 A
TOTAL FEE , FINAL
Plan check applicant 32 ,00 PLAN CHECK VALIDATION
Name +
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Address
City Tel No
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE -40090A
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION # • •'• • • 5
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS 2 t� V O
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE 37
LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY , r a a • �7
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S IOF PERM TTEE ` "I+2 Q v 0
DISTRICT NO PR CE ED BY
1-T-1 6)
INDUSTRIAL
WASTE APPROVAL
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