HomeMy Public PortalAbout5211AGNES AVE_Plumbing (4) 76A667 CE817 6 60
APPLICATION FOR PLUMIBING PERMIT �
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 521] Agnes St.a
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
WILLIAM A JENSEN SUPT OF BUILDING LOCALITY Temple City
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM OWNER E. Gean Davis
WATER CLOSET MAIL
ADDRESS 5211 Agnes St.,
BATH 7n Temple C C
crrY P Y TEL No
SHO` ` Inc- p
coNTsxcroa Anthony Pools s s
LAVATORY
RINs ADDRESS 5871 Fit e s to m S1vd. s
DISHWASHER crryS outh Gat a TEI. NO SP-32a o
CONTRACTOR S
LAUNDRY TUB REGISTRATION N190179 SC-53CsrOIINTYfY
CLOTHES WASHER DISTRI T NO GROUP ZONE P CESSED BY
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
a
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resh water piping
swim pool o
a
rn
0 $100 PER ITEM
OR FIXTURE $ 6t APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2 00 UNDER Si:!CB WORK
TOTAL FEE �-3 OO ROUGH PLUMBING
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS+ ANGELES COUNTY/AND STATE OF GAS TEST
CALIFORNIA OR THAT, AM HE LEGAL OW E r OF THE ABOVE
DESCRIBED RESIDENT L P ERTY.- G V, UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTE
®r AmATION ROBERT A WOOD
x ,
CAM SUPERVISING MECHANICAL ENG R
1'�07 2 .) 90 1'" 17 5 D 3 00