HomeMy Public PortalAbout4831AGNES AVE_Plumbing (4) 7"667AC
CE 817(REV 11/78) '
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY ,
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
ADDRESS483-1
NUMBER FIXTURE OR ITEM' ® FEE i
WATER CLOSET LOCALITY Temple Cit Unit-21C
2 c 00
NEAREST
BATH TUB r CROSS ST
IV
SHOWER 00 OWNER
LAVATORY MA
ADDRESS
IL
SINK 00 CITY TEL NO
DISHWASHER CONTRACTOR
Dorse Plumbing Co.
CLOTHES WASHER 00ADDRESS 80() pajOMareS
SWIMMING POOL RECEPTOR Q p
CITYin r TEL NO —0828
LAWN SPRINKLER SYSTEM
STATELIC
WATER HEATER 0 LICENSE NO 315421 421 CL SS B, C-36
GAS SYSTEM OUTLETS + APPROVALS DATE INSPECTOR S SIGNATURE O
OUTLETS OVER UNDER
5 PER SYSTEM ROUGH PLUMBING O
tr
GAS PIPING
GAS VENT F
HOT WATER HEATER
PLUMBING FIXTURES ,� w
GAS TEST d 4 4-0 CAdLA6 r-,_.-
Plan check fee UTILITYCO NOTIFIED
PLUMBING PERMIT ISSUING FEE$ 00 A
TOTAL FEE ` 00 FINAL :� ,K.yS. ••-
Plan check applicant PLAN CHECK VALIDATION
Name
Address
City 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 ORDINANCES0 0 7/�() n
A
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS # f G
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE e of r J
LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL r . * 3700 0 0 }
PROPERTY
SIGNATURE 'S a * 37002i
OF PERMITTEE
DISTRICT'NO PROCESSID BY 0 &28-80
INDUSTRIAL
WASTE APPROVAL +
1 r
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