HomeMy Public PortalAbout4833, 4825AGNES AVE_Plumbing (4) } �✓ f
76A667A n �
CE 817(REV 11/78) ,r
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY..t
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FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING J'o
ADDRESS 482 Law-e
NUMBER FIXTURE OR ITEM ® FEE
LOCALITY yLgi _
2 WATER CLOSET 1 6 00
NEAREST I
1 BATH TUB 3 00 CROSS ST 1
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1 SHOWER 00 OWNER Fairhaven Corp
LAVATORY MAIL
2 6 00 ADDRESS
1 SINK 00 CITY * TEL NO
DISHWASHER CONTRACTOR DorseyPlumbing' Co
1 CLOTHES WASHER " 3 00 ADDRESS
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SWIMMING POOL RECEPTOR HO Z m r
CITYLs Verne TEL NO 599
LAWN SPRINKLER SYSTEM
STATE LIC
1 WATER HEATER r0 LICENSE NO 315421 CLASS B, C-36
1 06
GAS SYSTEM- r OUTLETS 3 00 APPROVALS DATE I ECTOR S SIGNATURE O
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OUTLETS OVER UNDER SLAB WORK 'S=!s-•� rg
5 PER SYSTEM ROUGH PLUMBING 7-�,rFtJ �y�.{� 1 O
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I GAS VENT 4`w 1 H
HOT WATER HEATER _z
PLUMBING FIXTURES
GAS TEST (�. '-
Plan check fee UTILITYCO NOTIFIED Z7
PLUMBING PERMIT ISSUING FEE$ 900n
TOTAL FEE 00 FINAL
L PLAN CHECK VALIDATION
Plan check applicant xa f
Name r
Address �
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City Tel No �7 { x
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE ;E O O ! i A
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION + # o a o,O o 5
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE 21- 3700
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LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL J / V
PROPERTY
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SIGNATURE n
OF PERMITTEE O ik%2 8—8 O
DISTRICT NO r/ PROCE ED BY
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INDUSTRIAL x x 1
WASTE APPROVAL
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