HomeMy Public PortalAbout4833, 4825AGNES AVE_Plumbing (16) 76A667A i II
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
NUMBER FIXTURE OR ITEM ® FEE ADDRESS
2 WATER CLOSET r 6 OO LOCALITY Temple Cit NEAREST Unit-'16D
CROSS ST �ltJ-C�
/' BATH TUB OO
I SHOWER OO OWNER Fairhaven Corp
� MAIL
2t LAVATORY 6 OO ADDRESS
I SINK 3 00 CITY TEL NO
DISHWASHER CONTRACTOR Dorsey Plumbing Co
1 CLOTHES WASHER 300 ADDRESS
SWIMMING POOL RECEPTOR CITY Le Vezne TEL NO 509_0828
LAWN SPRINKLER SYSTEM
STATE LIC
1 WATER HEATER 3 00 LIC NSE NO 315421 CLASS B C- 6
APPROVALS DATE INSPECTOR S SIGNATURE
1 GAS SYSTEM OUTLETS 00 u
OUTLETS OVER UNDER SLAB WORK �gp�il�v—m..eTs'7 OC
5 PER SYSTEM ROUGH PLUMBING O
GAS PIPING A> u
GAS VENT H
HOT WATER HEATER Z
PLUMBING FIXTURES
GAS TEST Q 4-n
Plon check fee UTILITYCO NOTIFIED
PLUMBING PERMIT ISSUING FEE$ 00
TOTAL FEE FINAL
Plan check applicant
PLAN CHECK VALIDATION
Name ;p vo 816 A
Address
City Tel No
# OO`OOO5
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE 2 0 0 3 7 0 0
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION 1 Q Q Q 3 7 0 0 5
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS F
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE 04.28-80
LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY
b
SIGNATURE
OF PERMITTEE
DISTRICT NO r P30CESSECIBY
1 10— Gr
INDUSTRIAL
WASTE APPROVAL