HomeMy Public PortalAbout4833, 4825AGNES AVE_Plumbing r
76A667A /
CE 817(REV 11/78)
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPEI BUILDING '1 0
NUMBER FIXTURE OR ITEM ® FEE 8
ADDRESS `
2 WATER CLOSET 6 00 LOCALITY Temple City Unit—'1 OF.
NEAREST 41
1 BATH TUB 00 CROSS ST
1 SHOWER 3
00 OWNER Fairhaven Corp
MAIL
2 LAVATORY 6 00 ADDRESS
I SINK 00 CITY TEL NO
DISHWASHER CONTRACTOR
Dorsey Plumbing Co
1 CLOTHES WASHER 00 ADDRESS
800 Palomares
SWIMMING POOL RECEPTOR
LAWN SPRINKLER SYSTEM CITY La Verne TEL NO -0828
STATE LIC
WATER HEATER00 LICENSE NO 315421 CLASS B1 C-36 a
GAS SYSTEM OUTLETS 00 APPROVALS DATE INSPECTOR S SIGNATURE O
UNDER SLAB WORK --/yam v
OUTLETS OVER
5 PER SYSTEM ROUGH PLUMBING 7-2-017
O
GAS PIPING „ W
GAS VENT H
HOT WATER HEATER Z_
PLUMBING FIXTURES
GAS TEST /p $-9)0
Plan check fee UTILITY CO NOTIFIED
PLUMBING PERMIT ISSUING FEE$ 00 I
TOTAL FEE 00 FINAL
Plan check applicant PLAN CHECK VALIDATION r
r
Name
Address
City Tel No
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE 2 0 0 7 4 A
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION # O O O O D 5
1 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 2 - 3700
LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY
0003700
SIGNATURE O k 2 8y 8 0
OF PERMITTEE
DISTRICT NO PROCESSED B
INDUSTRIAL
WASTE APPROVAL
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