HomeMy Public PortalAbout5732AGNES AVE_Plumbing (3) DES 17 12 B4 APPLICATION FOR PLUMBING PERMIT
DBS 17
DMSION OF BUILDING AND SAFETY
Deportment of County Engmeer
County of Los Angeles
WM J FOX COUNTY ENGINEER BUILDING
ADDRESS
CASSATT D GRIFFIN SUP T of BUILDING
LOCALITY
FOR APPLIPANT TO FILL IN NEAREST
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CROSS ST
OWNER DISTRICT NO I GROUP I Zq,N� READY FOR INSPECTION
MAIL
ADDRESS - f
INDUSTRIAL
CITY � �� TEL N WASTE APPROVAL
PLUMB s INSPECTION RECORD
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ADDRESS
CITY0, EL
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LICENSE NO
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) $
BATH TUB
SHOWER
LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER
TOTAL NO 080 APPROVALS
DATE INSPECTOR S SIGNATURE
GAS SYSTEM OUTLETS Q 100
UNDER SLAB WORK
WATER HEATER Cid too L
ROUGH PLUMBING
PERMIT S 1 00 GAS PIPING
LTOTAL FEE 4 O GAS VENT /+
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER �� LQ
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING
I HEREBY CERTIFY THAT AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO NOTIFIED
CALIFORNIA OR THAT 1 TH LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL OPE Y `
SIGNATURE
OF PERMITTFF --C FINAL
WILLIAM J FOX COUNTY ENGINEER VALIDATION
To3 2 4 61r" my 2 '3 200
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BY _ 1.�
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