HomeMy Public PortalAbout4949AGNES AVE_Plumbing (14) 76A667A ICE 817B) 11/76
APPLICATION FOR
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BUILD AND SAFETY DI ON � I
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
NUMBER FIXTURE OR ITEM Q FEE ADDRESS
WATER CLOSET LOCALITY
NEAREST
BATH TUB CROSS ST
SHOWER OWNER WIDERT, FART•
MAIL
LAVATORY ADDRESS
SINK 1 CITY TETLE CITY TEL NO 287-2793
DISHWASHER CONTRACTOR TRANE HCC
CLOTHES WASHER ADDRESS 2034 N PECK M -
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SWIMMING POOL RECEPTOR
q CITY S EL i TEL NO 579-7982
AWN SPRINKLER SYSTEM STATE LIC
WATER HEATER LICENSE NO i 265094 CLASS C-20
GAS SYSTEM OUTLETS 3 00 DISTRICT NO�nGROUP �PE CESSE Y
OUTLETS OVER 't9e Z i
5 PER SYSTEM INDUSTRIAL IA
WASTE APPROVAL O
INSPECTION RECORD V
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Plan check fee 4 ,50
PLUMBING PERMIT ISSUING FEE$
° ,TOTAL FEE 7 50
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Plan check applicant
APPROVALS DATE INSPECTOR S SIGNATURE
Name �
UNDER SLAB WORK
Address ROUGH PLUMBING
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City Tel No GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY LOS ANGELES COUNTY AND STATE OF ALIFORNIA OR THAT I AM THE GAS TEST r9 f..✓!7
LEGAL OWNER OF AND INTEND TO RESIDE IN T A OVE DESCRIBED RESIDENTIAL
PROPERTY /J UTILITY CO NOTIFIED y
SIGNATURE
OF PERMITTEE FINAL ep ir,C( +
PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION CK M o CASH
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