HomeMy Public PortalAbout4851TEMPLE CITY BLVD_Plumbing ' 76A667 (Cr�-8171-8-71
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADD
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FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS BT
NUMBER FIXTURE OR ITEM ® FEE
OWNER
WATER CLOSET 1 76 MAIL
BATH TUB 1 75 ADDRESS
SHOWER 1 75 CITY 01 TEL IN r D
LAVATORY 175 CONTRACTOR
SINK 1 75 ADDRESS
DISHWASHER 1 75 CI TEL NO
CLOTHES WASHER 1 75 STATE LIC
LICENSE NO / CLASS
SWIMMING POOL RECEPTOR 1 75
DISTRICT NO GROUP I ZONE PROCESSED BY
LAWN SPRINKLER SYSTEM 1 75 D — \
WATER HEATER 1 75 pp 96
WASTETARPROVAL Q
GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD V
OUTLETS OVER 30 O
5 PER SYSTEM
F`
U
W
d
N
Z
Plan check fee See reverse
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE
APPROVALS DATE INSPECTOR a SIGNATURE
Plan check applicant UNDER SLAB WORK
NaR1e ROUGH PLUMBING �V ,
Address GAS PIPING
City Tel NO GAS VENT
HOT WATER HEATER 1
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVC Ia CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR UTILITY CO NOTIFIED
LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIPORN IA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE OC HIRE RESIDE TIAL PROPERTY FINAL
SIGNATURE
OF PERMITTEE PERMIT VALIDATION (0
M 0 CAB.
PLAN CHECK VALIDATION CK M o CASH ^M ,�
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