HomeMy Public PortalAbout5728AGNES AVE_Plumbing 76 ICE 817A) 11/76
~j APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ` n
NUMBER FIXTURE OR ITEM @ FEE ADDRESS
WATER CLOSET LOCALITY
NEAREST
BATH TUB CROSS ST
SHOWER OWNER
LAVATORY MAI L
ADDRESS AV
SINK CITYL= TEL NO
DISHWASHER CONTRACTOR
1
CLOTHES WASHER
ADDRESS 57119
/ SWIMMING POOL RECEPTOR
CITY � TEL NO�
LAWN SPRINKLER SYSTEM
STATELIC
WATER HEATER LICENSE NO I CLASS
GAS SYSTEM OUTLETS DISTRICT N(}; UP, IO,E PPOCESSgD BY
OUTLETS OVER Cpl^'' •�C/C�_!/ �� y�
5 PER SYSTEM INDUSTRIAL �.
WASTE APPROVAL O
INSPECTION RECORD
c
A
B�
to
z
Plan check fee
PLUMBING PERMIT ISSUING FEE$ 7 oo
TOTAL FEE r�
Plan check applicant
APPROVALS DATE INSPECTOR S SIGNATURE
Name
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel No GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THATTHE 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 D/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY LOS ANGELES COUAN ATE CALIFO IA OR THAT I AM THE GAS TESTer
LEGAL OWNER OF AND INTE O 9t IN BOVE SCRIBED RESIDE TIAL
PROPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
PLAN CHECK VALIDATION CK o CASH PURMIT VA DATION M o CASH
367eMAY 9 5 0 1 G0L ���