HomeMy Public PortalAbout4805TEMPLE CITY BLVD_Plumbing (2) 7% A 667-s CE 817 7-69 `
APPLICATION FOR PLUMBING PERMI
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER imLDDID
BUILDING AND SAFETY DPALSION ADDRESS - C
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY C ff 7'- ,y
FOR APPLICANT TO FILL IN PR NT O TYPE NEAREST
E�O�87 L N T
NUMBER FIXTURE OR ITEM EACH FEE
OWNERrefs _
WATER CLOSET 1 50 MAIL '
BATH TUB 1 50 ADDRESS
SHOWER 150 CRY TEL NO
LAVATORY 150 CORIMCTOH DB4J
SINK 15o ADDRESS y /
DISHWASHER 1 50 CRT w 0 #'nm IID 3.3 3
CLOTHES WASHER 150 STATE LIC
LICENSE NO / 0 P" CLASS
SWIMMING POOL RECEPTOR 1 50 D.BTRICT GR UP ZONE B BY
LAWN SPRINKLER SYSTEM 7 00 • -7 �T
WATER HEATER 1 SO INDWASTE A ROv ��✓qq. 3 .-Z9—'7p A�
/
GASSYS TEM OUTLETS 150 ON SEC 8
OUTLETS OVER
5 PER SYSTEM 30 ZS O Z
e) K °
1 � c
Plan check fee 25% of above See reverse
PLUMBING PERMIT ISSUING FEE S 2 00
TOTAL FEE APPROVALS DATE Rj CTOR a SIGNATURE
Plan check applicant UNDER SLAB WORK
Narne ROUGH PLUMBINGJW I
Address GAS PIPING
City Tel No GAS VENT
HOT WATER HEATER
I HERESY ACICHOWLEDGE THAT I NA READ THIS APPLICATION
AND [TAT[ THAT THE ABOVE IS CARRICr AND AGR[[ TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY OROINANC[S AND BY
LAWS R[ODUTPNG GAS TEST 4
PLUMBING
1 H¢RmY CERTIFY THAT I AM PBGPERLY R[Glrt¢IIEo Arm/oN UTILITY CO NOTIFIED
LIC[Nt[D AS 11[OUIR[D BY LOS ANO¢LU COUNTY AMD STATE OF
CALIFORNIA ON THAT 1 AM THE LEGAL HER OF ANO INTEND TO
11[SIO[ IN THE ABOVE D[ IB[D RESI IAL PIN P[IRY FINAL
SIGNATURE
OF JACK R. ALLEN, SUPERVISI HANICAL ENG'R
FiRMITTE!
PEENIIT VALH)AT10 cH M o cwaN
PLAN CHECK VALID ON CN M o CASH
IP('
4222R MAR2_ 5 5 0 2650