HomeMy Public PortalAbout5823AGNES AVE_Plumbing (3) 76A667 (CE 817) 4/72
APPLICATION FOR PLUMBING PERMIT {�
COUNTY OF LOS ANGELES u
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO BUILDING Qr/q
ADDRESS
HARVEY T BRANDT COUNTY ENGINEER LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
NUMBER FIXTURE OR ITEM @ FEE CROSS ST
OWNER
WATER CLOSET 1 75
MAIL
BATH TUB 1 75 ADDRESS
SHOWER 1 75 CITY G TEL NO
LAVATORY 1 75 CONTRACTAR
SINK 1 75 ADDRESS t `
DISHWASHER 1 75 CITY TEL NO
CLOTHES WASHER 1 75 STATE //y �/ LIC
SWIMMING POOL RECEPTOR 1 75 LICENSE / U / CLASS
DJSTRIC?O f P NE C
LAWN SPRINKLER SYSTEM 1 75 ..""VV��
WATER HEATER 1 75 INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD V
OUTLETS OVER 30 C
5 PER SYSTEM
C~7
4!
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Cn
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE
APPROVALS DATE INSPECTOR S SIfNA T(.RE
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
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING GAS TEST
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF /
CALIFORNIA OR THAT I AM T E LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DEARE ED RESIDENTIAL PROPERTY) FINAL
SIGNATU RE
OF PERMITTEE
PERMIT VALIDATION CK M 0 cases
J
PLAN CHECK VALIDATION CK M 0 CASH
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