HomeMy Public PortalAbout5210AGNES AVE_Plumbing (2) 76A607-CE817 10 60
IAPPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVLSION BUILDING /Q
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
WILLIAM A JENSEN SUP T OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM OWNER
WATER CLOSET I�III.
BATH TUB ADDRESS J
CITY NO
SHOWER
LAVATORY CONTRACTOR
SINS ADDRESS - Al
DISHWASHER CITY TEL NO a-�j�/S"/
CO OR S
LAUNDRY TUB REGISTRATION NO �'g Sr— COUNATTY
CLOTHES WASHER DISTRICT NOGROUP ESSED BY
WATER HEATER �a
l GAS SYSTEM INDUSTRIAL
WASTE APPROV >-
/ INSPECTION RECORD a
u
V
Lu
00 PER ITEM
OR FIXTURE $ APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING ` � M I
GAS PIPING I. ki 2.---
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION / v
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING HOT WATER HEATER
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES I �'� q� 75-?,
LICENSED A3 REQUIRED A LT ANGELES COUNTY AND STATE OF GAS TEST /��9//F�, ' y�1,� ^ �1?wAf
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE � JJ!!
DESCRIBED RESIDEN O ERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMI _
VALIDATIOrROBERT A WOOD
CK M O (:;H5A
SUPERVISING MECHANICAL ENG R
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