HomeMy Public PortalAbout5210AGNES AVE_Plumbing (12) DES 17 APPLICATION FOR PLUMBING PERMIT
oBs 17 10
OF BUILDING AND SAFETY
Department of County Engmeer
County of Los Angeles BUILDING /1
JOHN A LAMBIE COUNTY ENGINEER ADDRESS (/
CASSATT D GRIFFIN SUP T OF BUILDING
LOCALITY
FOR 4ULICANT TO FILL IN NEAREST
CROSS ST
OWNER .r DISTRICT NO G OUPd ZONE I READY FOR INSPECTION
MAIL ` 16198// 4-/
ADDRESS
INDUSTRIAL
CITY r TEL NO WASTE APPROVAL
PLUMBER dip -�, INSPECTION RECORD
ADDRESS v"y @� �. y -�L
W
CITY A ` TEL NO
LICENSE NO
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1 00 $
BATH TUB @ $1 00
SHOWER @ $1 00
I
LAVATORY (WASH BASIN) @ 3100
KITCHEN SINK @ $1 00
DISHWASHER @ $1 00
LAUNDRY TUB OR TRAY @ $1 00
CLOTHES WASHER @ $100
WATER HEATER @ $100 Q�
GAS SYSTEM @ $1 00
APPROVALS
DATE INSPECTOR S SIGNATURE
UNDER SLAB WORK
PERMIT $ I 1 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE GAS VENT 4
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 1 AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF - -
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF HE ABOVE UTILITY CO NOTIFIED
DESCRIBED RESIDENTIAL PROPERTY `
SIGNATUREr�
OF PERM ITTEEe�- ��Zil FINAL �,7
U
JOHN A LAMBIE COUNTY ENGINEER VALIDATI ROBERT A WOOD CHIEF PLBG INSPECTOR
CK IA 0 CASH
246 - SEP19 3 300