HomeMy Public PortalAbout4922AGNES AVE_Plumbing (4) 76A667 CE817 12/59
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APPLICATION FOR PLUMPING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDINGLkND E, YETY RIVISION BUDS ry
JOHN A MBI OUNTY NGINEER
WILLIAM A JENSEN SUPT OF BUILDING
- — LOCALITY i
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET MAIL
BATH TUB ADDRESS
CI
SHOWER
LAVATORY CONTRACTO
ADDRESS
SINS
DISHWASHER CITY Iry
NO
CONTRACTOR SV STATE ❑
LAUNDRY TUB REGISTRATION NO COUNTY ❑
CLOTHES WASHER DISTRICT NO GROUP z PMPCESSED BY
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORDIF
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U
PC
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V1
1
0 $100 PER ITEM
OR FIXTURE
$ APPROVALS DATE_ INSPECTOR S SIGNATURE
PERMIT $ I 2100 UNDER SLAB WORK
TOTAL FEE I ,eAl ROUGH PLUMBING `
�I� ) GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL PLUMBING COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER {
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES A
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST ��� e�
CALIFORNIA OR THAT AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTI PROPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTE
FINAL
®F VALIDATION ROBERT A WOOD
CH m o cesx SUPERVISING MECHANICAL ENG R
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