HomeMy Public PortalAbout4901AGNES AVE_Plumbing (5) 76A667 CE817 1157
APPLICATION FOR PLUMBING PERMIT r
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BULDING AND SAFETY DIVISION BUILDING
'
C1�SOHN A LAMSIE County.Eagmeer ADDRESS y.0
SATT D GREFFIN Sup t of Buddmg LOCALITY
FOR APPLICANT TO FML IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM
WATER CLOSET OWNER
IIAIL ••''
BATH TUB ADDRESS Fi- pIf
SHOWER CITY TEL NO
LAVATORY CONTRACTOR
Smg ADDRESS `/
DISHWASHER CITY 0&1VAtt TEL NO jf `)
CONTRACTOR S f STATE
LAUNDRY TUB REGISTRATION NO / �'s3 d COUNTY Ecl
CLOTHES WASHER DISTRI O GR ZONE I READY FOR INSPECTION
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
rye/ Er_,P
r
APPROVALS
/ 0 $100 PER ITEM DATE INSPECTOR S SIGNATURE
OR F18TUHE $ I Lip
UNDER SLAB WORK
PERMIT $ 00 ROUGH PLUMBING
TOTAL FEE e p GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING PLUMBING FIXTURES
1ICHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LENSED AS REQUIREDBY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED
DESCRIBED RESIDENTIAL PROPERTY
SIGNATURE /�¢�L�
OF PERMITTEE �'.h. FINAL
ROBERTA WOOD
OF VALIDATION SUPERVISING MECHANICAL EN
_ CK N `
t
it 4 _ !�, aT904A APR 30 5 A 300 M
, 1•
LACO 5-1000 APR 30 5A 3e0011)