HomeMy Public PortalAbout5210AGNES AVE_Plumbing (5) OBS 17( APPLICATION FOR PLUMBING PERMIT 1
DBS DIVISION OF BUILDING AND SAFETY
Deportment of County Engmeer
County of Los Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS f
CASSATT D GRIFFIN SUP T OF BUILDING �^
LOCALITY C
FOR APPLICANT TO FILL IN NEAREST-CROSS
EAREST l
/^� CROSS ST / x/
OWNER L_ H �/ DISTRICT NO GROUP , I READY FOR INSPECTION
MAIL
ADDRESS .vee L
INDUSTRIAL
CITY ` ! TEL NO WASTE APPROVAL
R_ zA L_ F004- INSPECTION RECORD
ADDRESS ot
CITY / TEL NO
LICENSE NO /4-3
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1 00 $
BATH TUB @ $100
SHOWER @ $100
LAVATORY (WASH BASIN) @ $1 00
KITCHEN SINK @ $1 00
DISHWASHER @ $1 00
LAUNDRY TUB OR TRAY @ $1 00
CLOTHES WASHER @ $1 00
WATER HEATER @ $1 00
GAS SYSTEM @ $1 00
re r — U
APPROVALS
DATE INSPECTOR S SIGNATURE
UNDER SLAB WORK
PERMIT $ t 00 ROUGH PLUMBING
GAS PIPING ,x
TOTAL FEE Z ao GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS NGEL S UNTY AND STATE OF
CALIFORNIA OR THAT I AM ,P THE ABOVE UTILITY CO NOTIFIED
DESCRIBED RESIDENTIAL P RT
A
SIGNATURE �q 1
OF PERMITTEE FINAL
JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
VALIDATION
O CASH
�� 3 0 )� JUL 17 3 200 n
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