HomeMy Public PortalAbout4833, 4825AGNES AVE_Plumbing (3) 76A667A 7 , �� t
CE 817(REV 11/78)
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
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FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
ADDRESS 4825
NUMBER FIXTURE OR ITEM ® FEE
2 WATER CLOSET 6 -90— LOCALITY Temple Cilt nit—
N EAREST
1 2C
1 BATH TUB 00 CROSS ST
1 SHOWER 00 OWNER Fairboven Corp
MAIL
2 LAVATORY 6100 ADDRESS
e
SINK j CITY TEL NO
DISHWASHER CONTRACTOR Dorsey Plumbing Co
1 CLOTHES WASHER 3 00 ADDRESS
SWIMMING POOL RECEPTOR CITY Le Verne TEL NO 599-0828
LAWN SPRINKLER SYSTEM
)TATE LIC
WATER HEATER00 LIC NSE NO 315421 CL SSB C-36 >.
1 GAS SYS EM OUTLETS00 APPROVALS DATE INSPECTOR S SIGNATURE
OUTLETS OVER UNDER SLAB WORK .5—/1rW v
09
5 PER SYSTEM ROUGH PLUMBING —2--1'0 0
GAS PIPING `v
GAS VENT h
HOT WATER HEATER z
PLUMBING FIXTURES A `
GAS TEST
Plan check fee UTILITY CO NOTIFIED r✓
PLUMBING PERMIT ISSUING FEE$ 00 A
TOTAL FEE 1 371
00 FINAL
Plan check applicant PLAN CHECK VALIDATION
Nome
Address
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City Tel No
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE ;90072A
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION # 0 010 O 05
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 r 0 - 370050
N
SIGNATURE
OF PERMITTEE- 0423-80
DISTRICT NO PROCESSE BY
INDUSTRIAL
WASTE APPROVAL
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