HomeMy Public PortalAbout5210AGNES AVE_Plumbing (6) 1 `
76?1667A ,
CE 8171F&V 6/78)
5
APPLICATION F R PL U M B �NG PERMIT
COUNTY OF LOS ANGELES BUILDING.A7 SAFETY
a
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING l/�
d CSU
NUMBER FIXTURE OR ITEM @ FEE ADDRESS Z
477
WATER CLOSET LOCALITY -
NEAREST
'
BATH TUB CROSS ST
SHOWER OWNER
r
LAVATORY MAIL
ADDRESS
SINK CITY TEL NO
DISHWASHER CONTRACTOR
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL NO /kf
LAWN SPRINKLER SYSTEM /
LIC
WATER HEATER
LICENSE NO 2 Q6 yO CLASS e -3
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING
GAS PIPING 0
GAS VENT
HOT WATER HEATER O
PLUMBING FIXTURES
GAS TEST 6L
Plan check fee UTILITY CO NOTIFIED Z
PLUMBING PERMIT ISSUING FEE$ -71
TOTAL FEE FINAL
Plan check applicant
PLAN CHECK VALIDATI N
Nome
Address
City Tel No
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES @ Q 8 b 9 A
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS O O O D O 5
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT i AM THE
LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL O 0 O 1000
1 0 Q Q
PROPERTY 1 L
SIGNATURE 'O 0 0 1 Q O O V
OF PERMITTED/
'IQ18-78
DISTR T NO "22PROC95SED B
INDUSTRIAL
WASTE APPROVAL