HomeMy Public PortalAbout5210AGNES AVE_Plumbing (17) 76A6S7A {CE Ok 7B) 4/77
APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIV ION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
NUMBER FIXTURE OR ITEM @ FEE ADDRESS
WATER CLOSET LOCALITY
BATH TUB NEAREST
� CRO55 ST
SHOWER OWNER
J LAVATORY MAIL
ADDRESS [
SINK CITY — ,y� C� TEL NO 7-840"'
DISHWASHER CONTRACTOR /'t'U JV
CLOTHES WASHER
ADDRESS I � I �.� LJ POOL RECEPTOR
4 Ly
CITY C) N 2 O uTEL NO
LAWN SPRINKLER SYSTEM /
STATELIC3
WATER HEATER LICENSE NO �t T $ CLASS C^
GAS SYSTEM OUTLETS
DISTRICT NO PVUP =ZkNEPR CESSED Y
hhr
OUTLETS OVER J` V —✓ O
5 PER SYSTEM INDUSTRIAL V
WASTE APPROVAL
INSPECTION RECORD CD
H
U
�v �S/ u,
C-/)
Plan check fee
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE
Plan check applicant
Name APPROVALS DATE INSPE_TO IS SIGNATURE
UNDER SLAB WORK
Address ROUGH PLUMBING .( 8
City Tel No GAS PIPING
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY LOS ANGELES NTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF AND IN ND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY UTILITYCO NOTIFIED
C
SIGNATURE `
Per INAL 17-8 1
PLAN CHECK VALIDATION CK MO CASH PERMIT VALIDATION M Q CASH
POLICY HOLDER%-t�-,,C, 7 6 6 Aft 6 5 U 2 2 0 U ,&Z�,,
POLICY NUMBER W075-If'-' 7 -
r-P Y-1-DD