HomeMy Public PortalAbout4800TEMPLE CITY BLVD_Plumbing Tswu)e Ice-01 vs) -HTS
APPLICATION FOR PLUMBING PERMIT {�
�J
BUILDING SAFETY DIV[ N `
FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
NUMBER FI%T URE OR ITEM ® FEE ADDRESS
LOCALITY
WATER CLOSET
NEAREST
BATH TUB CROSS ST
SHOWER OWNER
MAIL
LAVATORY ADDRESS
,006 '221d AT4.," . I
SINK 6 CITY TEL NO IF
DISHWASHER CONTRACTOR
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR TEL NO p
CITY
6
LAWN SPRINKLER SYSTEM STATE �j
LICENSE NO 6 /-tom CLASS J
/ WATER HEATER C.)
DISTRICT NO GROVP ZONE ESS BY
GAS SYSTEM OUTLETS � p
OUTLETS OVER $7 L 1 •, L� V
5 PER SYSTEM ell WASTE APPPOVAIey /`�'
INSPECTION RECORD Z
Plan check fee
PLUMBING PERMIT ISSUING FEE S �T�
TOTAL FEE 7�
Plan check applicant
APPROVALS DATE INR Pcc row B B.cNAr uec
Name
UNDER SLAB WORK Q�
Address ROUGH PLUMBING
City Tel NO GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AOREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REOULATINO HOT WATER HEATER
PLUMBING PLUMBING FIXTURES
I HER CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOB ANGELES COUNTY ANO STATE OF GAS TEST
CALIFONNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO
RESIDE IN THE ASOVE DESCRIBED RESIDENTIALPN ERTY UTILITY CO NOTIFIED
SIONATU RE
OF PERMITTEE FINAL 77 1
PLAN CHECK VALIDATION _ CK M D 01 OF CASH PERMIT VALIDATION cK M G CASH
9 8 6�OCT c8 5 0 4 35 0 •