HomeMy Public PortalAbout4343TEMPLE CITY BLVD_Plumbing (2) 76A667A or Crrr
CE 817(REV 1 I/781
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING L
NUMBER FIXTURE OR ITEM ® FEE ADDRESS
LOCALITY rn [
WATER CLOSET _ ✓n a '1
NEAREST
BATH TUB CROSS S7 W -
SHOWER OWNER '/✓Rive EaG10C. /Y//
LAVATORY ADDRESS ''/ LG 1/
SINK CIT �JgI5: T N
DISHWASHER CONTRACTOR (. C l+U
CLOTHES WASHER ADDRESS Q L/ ✓E
SWIMMING POOL RECEPTOR �� .�L,
CITY TEL N� l�S/i
LAWN SPRINKLER SYSTEMSTATE �J
LIC
WATER HEATER LICENSE Ncd -zl ;"99 / CLASS 15
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE
OUTLETS OVER UNDER SLAB WORK y
5 PER SYSTEM ROUGH PLUMBING Ly
GAS PIPING V
GAS VENT K
HOT WATER HEATER O
PLUMBING FIXTURES (WWW666,
GAS TEST E�
Plan check fee J� FINAL
TY CO NOTIFIED Z
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE 7�Z,;—
Plan check applicant PLAN CHECK VALIDATION
Name
Address
City Tel No /'� /� /y; tlf.V//���I"���• (Y
I HEREBY
KNO LEDGE
S APPLICATION AND STATE
THAT THE ABOVE SIS CORRECT ECT AND TAGREE TO COMPLHAT I HAVE Y WITH ALL COUNTY ORDINANCES
Y A
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION # • rj
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
REOWRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE < Q O O
LEGAL OWNER OF AND ND TO RESIDE IN THE ABOVE DESCR ED RESIDENTIAL
PROPERTY /� Lei. * I O O Q U
SIGNATURE //'C6_
aPPERFAITTEE 0602,-80
DISTRICTNONOFy, P CESSED BY
U O -
INDUSTRIAL
WASTE APPROVAL