HomeMy Public PortalAbout4800TEMPLE CITY BLVD_Plumbing (2) 76AG97C (e¢-U Ta) -O/1E
APPLICATION FOR PLUMBING PERMIT
BUILDINGD SAFETY DIVISION
FOR APPLICANT TO FILL IN IFRINT OR TY PEI BUILDING
IS 1800 Iem? e of4 $ 0)
NUMBER FIKTURE OR ITEM FEE
ADDRE
WATER CLOSET LOCALITY
NEAREST
BATH TUB
CROSS ST
SHOWER OWNER SOV 0
LAVATORY MAIL
ADDRESS
SINK CITY TEL NO
DISHWASHER CONTRACTOR `/ t i C
CLOTHES WASHER ADDRESS 3 Y D r l� O/ v 1
SWIMMING POOL RECEPTOR
LAWN SPRINKLER SYSTEM CITY ' v S 'We TEL NO 6 70
WATER HEATER LICENSE NO 221 STATE LIC
C LA$$ O
GAS SYSTEM OUTLETS DIST
R NO GROUP 20NE ESSED BY U
u B 0_ CD
OUTLETS OVER CD
5 PER SYSTEM INDU$7 REAL w
WASiE AVPROVAL y
INSPECTION RECORD Z
Plan check lee
PLUMBING PERMIT ISSUING FEE S
TOTAL FEE Q
Plan check applicant
Name APPROVALS DATE INSPECTOR S SIGNATURE
UNDER SLAB WORK
Address _ ROUGH PLUMBING
City Tel NO GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ASO VE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUM BI NO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AMD/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE D SCRISEO RESIDENTIAL PRO RTT UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
PLAN CHECK V DATION dr G CASH PERMIT VALIDATIO CK M D CASH
2-011t"JAM 1 / 5 u 0.5 0 ♦t)D