HomeMy Public PortalAbout4906AGNES AVE_Plumbing (6) 76A887/ E 817) 175
° ` APPLICAT'10 F PLUMBK6 PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY.ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO FNEAREST
ILDING i
DRESS �` (J '�
HARVEY T BRANDT COUNTY ENGINEER
CAL( r
FOR APPLICANT TO FILL IN (PRINT OR TYPE( s
OSS ST .�
NUMBER FIXTURE OR ITEM p @ FEE
WATER CLOSET
2 00 OWNER
MAIL ,$ f
BATH TUB ; 200 ADDRESS (p
SHOWER 200 CITY TEL NO
LAVATORY 200 CONTRACTOR
SINK 200 ADDRESS
DISHWASHER 20 CITY /��✓L�Q J��/� TEL NO � 1�?
CLOTHES WASHER 200 STATE LIC NO p{ T �"/`" CLASS e7 39!-
SWIMMING POOL RECEPTOR 200
DISTRICT NO JGROUPQZONE PRO ESSE BY
LAWN SPRINKLER SYSTEM
200 � Q f_
WATER HEATER I 200 INDUSTRIAL
GAS SYSTEM OUTLETS 200 3 UU WASTE APPPROVAL INSPECTION RECORD
OUTLETS OVER , v
5 PER SYSTEM 30 t
CdO
1
I.—
Plan
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $
4
TOTAL FEE
APPROVALS DATE INSPECTOR 9 SIGNATURE
Plan check applicant UNDER SLAB WORK
Name r ROUGH PLUMBING
Address GAS PIPING ;��-7
Clty Tel NO GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THEABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES ..+v
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ]�
PLUMBING 1 GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES gOUNTY AN STATE qF
CALIFORNIA OR THAT I AM LEGAL 0 ER Q0 A INTEND
RESIDE IN THE ABOVE DES I R IDE IAL OP FINAL J a•�A��I' � ,
SIGNATURE �� L. o'
OF PERMITTEE
PERMIT (DATION cK M o cases
PLAN CHECK VALIDATION cK M o CASH
7 9 8'-ww P. 5 D 7 5 0 n=om
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