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HomeMy Public PortalAbout4833, 4825AGNES AVE_Plumbing (2) 76A667A CE 817(REV 11/78) APPLICATION FOR PLUMBING PERMIT 11 COUNTY OF LOS ANGELES BUILDING AND SAFETY .� FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING /�.82 �� NUMBER FIXTURE OR ITEM @FEE ADDRESS ` 2 WATER CLOSET 6 00 LOCALITY TeMple TempleQit, Unite-11D NEAREST 1 BATH TUB 3 00 CROSS ST SHOWER OWNER Fairhaven Co MAIL 2 LAVATORY 6 O0 ADDRESS SINK _QDCITY TEL NO DISHWASHER CONTRACTOR Dorsey Plumbing Co CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR LAWN SPRINKLER SYSTEM CITY Le Verne TEL NO 599-0828 iTATELIC 1 WATER HEATER LICENSE NO 315421 CLASS B, C-36 1 APPROVALS DATE INSPECTOR S SIGNATURE 0 GAS SYSTEM OUTLETS 3 OO OUTLETS OVER UNDER SLAB WORK sal irk 19 5 PER SYSTEM ROUGH PLUMBING D GAS PIPING _ u GAS VENT 0- N HOT WATER HEATER C./ Z PLUMBING FIXTURES GAS TEST v - (� Plan check fee UTILITY CO NOTIFIED PLUMBING PERMIT ISSUING FEE$ ' 00 TOTAL FEE 37 00 FINAL Plan check applicant PLAN CHECK VALIDATION Name Address City Tel No A 0 0 7 3 A I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION ` # o o o O o 5 IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS 2 - 3700 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 PROPERTY t0 0 0 3 7 0 0 5 SIGF NATURE P © AL L. C�2 B-8 0 OE RMITTE 4 DICT NO PR CESSE BY ' i Qdp-� INDUSTRIAL { WASTE APPROVAL