HomeMy Public PortalAbout5218AGNES AVE_Plumbing (2) n I
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76A667A ICE 9t71B1 11/76
APPLICATION FOR PLUMBING PERMIT
BU ING AND SAF DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING [0��# 5 218 N o Agnes
NUMBER FIXTURE OR ITEM ® FEE ADDRESS 7�
I WATER CLOSET LOCALITY Temple C i t
NEAREST
BATHTUB CROSSST gowland Drive
1 SHOWER OWNER w. Coe
MAIL
1 LAVATORY ADDRESS 5218 N o Agnes
SINK CITY Temple City TEL NO 287-2713
DISHWASHER CONTRACTOR Wo Eo Graham
CLOTHES WASHER ADDRESS 9127 Las L=iF Tunas Dr
SWIMMING POOL RECEPTOR
uTYTemple City TEL No 286-9293
LAWN SPRINKLER SYSTEM STATE LIC
WATER HEATER LICENSENO 104466 CLASS C-36
GAS SYSTEM OUTLETS
DISTRICT NO GROUP 1.Z NE OCESSE Y
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OUTLETS OVER 0
5 PER SYSTEM INDUSTRIAL
WASTE APPROVAL
lin om malINSPECTION RECORD uSewe
In
sewe o new bath o
ox 65 f 311CoIa M
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Plan check fee
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE JrU
Plan check applicant
APPROVALS DATE INSP TOR S SIGNATURE
Name UNDER SLAB WORK Z-4Z-7
Address ROUGH PLUMBING
City Tel No GAS PIPING
I HEREBY 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 COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED R IDENTIAL
PROPERTYUTILITY CO NOTIFIED
10,
SIGNATURE
OF PERM ITTEE 4— FINAL
C,
PLAN CHECK VALIDATION CK M o eASH PERMIT VALIDATION (:2z
cK M O CASH
9 0 5 LZ ON 30 5 d 1 3 5 Ci ,&",
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