HomeMy Public PortalAbout5218AGNES AVE_Plumbing (3) 7eA667 (CE 817) 5/73
✓APPLICATION FO PLUMBING PERMIT
COUNTY OF LOS ANGELES `
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO 7ADDRESS
�HARVEY T BRANDT COUNTY ENGINEER FOR APPLICANT TO FILL IN (PRINT OR TYPE)NUMBER FIXTURE OR ITEM @ FEE
WATER CLOSET 1 75 3
MAIL
BATH TUB 1 75 ADDRESS
SHOWER 1 75 CITY I TEL NO
LAVATORY 1 75 CONTRACTOR
SINK 1 75 ADDRESS
DISHWASHER 1 75 CITY L N
CLOTHES WASHER 1 75 STATELIC
LICENSE NO CLASS
SWIMMING POOL RECEPTOR 1 75
DISTRICT NO , UP N CESSED BY
LAWN SPRINKLER SYSTEM 1 75 /
WATER HEATER 1 75 INDUSTRIAL Q��
ASTE APPROVAL
GAS SYSTEM OUTLETS 1 75 ` INSPECTION RECORD CD
OUTLETS OVER
5 PER SYSTEM 30 o
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Plan check fee See Reverse
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PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE
APPROVALS DATE INSPECTOR 5 SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel NO GAS VENT
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES ,y
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING GAS TEST
I HER CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED 5 EgUIRED BY L05 ANGELES COUNTY AND STATE OF n
CALIFORNIA R AT I LEGAL OWNER OF AND INTEND TO / 049 A- C l�-/J 7y
RESIDE IN TH D CRIBED RESIDENTIAL PROPERTY FINAL /2--7I
SI GNATUR
OF PERMI EE
PERMIT VALIDATI OCM O CASH
PLAN CHECK VALIDATION CK M O CASH
610t-INOV 4 5 D 650 ®�j8