HomeMy Public PortalAbout4958AGNES AVE_Plumbing (5) 76A887 17 a as® APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J FOX CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO GROUP ZONE PERMIT
EMIT N O
PLUMBER s RECEIVED BY READY FOR DATE ISSUED
�FaIRST INSPECTION
ADDRESS [,�/ ADIy'U��(I - /17 U (�P ry f 0
��� BUILDING /�
CITY TEL r /! DRESS �
COUNTY LOCALITY
LICENSE NO EXPIRES NEAREST
PERMIT FEES
CROSS ST
/JI
NUMBER TYPE OF FIXTURE OR ITEM OWNER
FEE
MAIL
WATER CLOSET (TOILET) @ O 50 $ ADDRESS
BATH TUB @ O 50 CITY TEL NO
SHOWER @ O 50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ O 50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK @ O 50 STATE LAWS REGULATING PLUMBING
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ O 50 ANGELES COUNTY LICENSE 0 1 AM TtJE LEGAL OWNER
OF THE RESIDENTIAL,FROPEIW. DESCRI D ABOV
GAS SYSTEM OUTLETS Q O 50 SIGNATURE OF
WATER HEATER @ O 50 PERMITTEE -�
SLOP SINK Q O 50 INSPECTION RECORD
FLOOR SINK @ O 50
FLOOR DRAIN @ O 50
DISHWASHER @ O 50
DRINKING FOUNTAIN @ O 50
URINAL @ O 50
HOUSE SEWER @ O 50 Q
Z
MISCELLANEOUS U'
O
APPROVALS
DATE INSPECTOR S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT /
CESSPOOL Q 1 00 I �/ CESSPOOL
SEPTIC TANK I SEPTIC TANK
I DRAIN ( ) PIT ( ) Q 1 00 SEWER
PERMIT I 1 00 GAS TEST
UTILITY CO NOTIFIED i
TOTAL FEE $ ®®
FINAL yJ�