HomeMy Public PortalAbout5234AGNES AVE_Plumbing (2) 7fivA 667 - CE 817 7-69
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APPLICATION FOR PLUMBING PER IT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEAREST
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUPT OF BUILDING
FOR APPLICANT TO FILL IN (PR NT OR TYPE)
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET 1 50
MAIL
BATH TUB 1 50 ADDRESS
SHOWER 1 50 CITY TEL NO
LAVATORY 1 so CONTRACTOR
SINK 1 50 ADDRESS
DISHWASHER 1 50 CITY TEL NO
CLOTHES WASHER 1 50 STATE LIC
LICENSE NO G CLASS
SWIMMING POOL RECEPTOR 1 50 DISTRICT NO GROUP Z E P
TC
LAWN SPRINKLER SYSTEM 2 00 �r L
WATER HEATER 1 50 INDUSTRIAL d
WASTE APPROVAL Q
GAS SYSTEM OUTLETS 1 50 INSPECTION RECORD u
OUTLETS OVER 30 O Z
5 P SYSTEM
V
W
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Z
Plan check fee 25% of above See reverse
PLUMBING PERMIT ISSUING FEE S 2 00
TOTAL FEE
APPROVALS DATE INSPECTOR S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
C
ity Tel No
HOT WATER HEATER
EBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES 4.
LL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TESTNGEBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILIT IFIED
D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
NIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TOIN THE ABOVE DESCRIBED RESIDENT AL PROPS RT FINAL
URE JACK R ALLEN SUPERVISING MECHANICAL ENG R
RMITTEE
PERMIT VALIDATION cK ` M o CASH
PLAN CHECK VALIDATION CK M o CASH
r� 9 8 4 0C---' APR 2 2 5 D 650-