HomeMy Public PortalAbout5118AGNES AVE_Plumbing (3) 76 A 667=CEr3�7 4-6$
APPLICATION FOR PLUMBING P RMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
I WATER CLOSET 1 50
/ r
BATH TUB 1 50 Lrlo ADDRESS
SHOWER 150 CITY TEL NO
LAVATORY 1 50 DO CONTRACTOR
SINK 150 Q ADDRESS Q �`
DISHWASHER 1 50 CITY TEL NO
CLOTHES WASHER 1 50 d LSTATE
LIC
CENSE NO / ��
CLASS
SWIMMING POOL RECEPTOR 1 50
DISTRICT O GROUP ZONE PROCESSED BY >
LAWN SPRINKLER SYSTEM 2 00
O
WATER HEATER 1 50 INTE DUSTRIAL
GAS SYSTEM OUTLETS 1 50 INSPECTION RECORD O
OUTLETS OVER30 ����� e
5 PER SYSTEM � F
/ O N
r
Z
Plan check fee 25% of above See reverse
PLUMBING PERMIT ISSUING FEE 8 2 00
TOTAL FEE
APPROVALS 9ATE INS CTOR S,;iIGPIATURE
Plan check applicant UNDER SLAB WORK 412111.9 0
Name ROUGH PLUMBING /yr'(
Address GAS PIPING
GAS VENT 'gym
City Tel No HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED _ y
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF / q ,(p * 6R�
CALIFORNIA OR THAT I AM TLEGAL OWNER OF AND INTEND TO �Ajg tLl :ItA �
RESIDE IN THE ABO=I!/- TIA PERTYFINALSIGNATURE JACK R ALLEN SUPERVISING MECHANICA�A -
PLAN
OF PERMITTEE
PERMIT VALIDATION CK M o CHECK VALIDATION CK M o CASH
���'� 9 u 4 1lo ;x;28 5 a 1 (350-
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