HomeMy Public PortalAbout4851TEMPLE CITY BLVD_Plumbing (2) • 76A66*(CE-817)-B-71 �
P ,T APPL��TyyIOr�%R PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS �21 ,-rlr '
LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM ® FEE
OWNER
WATER CLOSET 1 75 MAIL
BATH TUB 1 76 ADDRESS /J
SHOWER 1 75 - 9 TEL NO
LAVATORY 175 CONTRACTOR Sl
SINK 1 75 ADDRESS 9" N
DISHWASHER 1 75 CITU L4 TEL NO
CLOTHES WASHER 1 76 STATE LIC
/�
SWIMMING POOL RECEPTOR 1 75 LICENSE NO CLASS
DISTRICT �Gfl UP ZO EC�N ROCS BY
LAWN SPRINKLER SYSTEM 1 75 J`qqII qq(//1 C•JY'
WATER HEATER 1 76 WASTETAbUOVAL Q
GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD (J
OUTLETS OVER
5 PER SYSTEM 30 Z
/ C F
• U
W
6
N
Plan check fee See reverse
PLUMBING PERMIT ISSUING FEE e 3 00
TOTAL FEE
APPROVALS DATE INSPECTOR a SIGNATURE
Plan check applicant UNDER SLAB WORK
Nagle ROUGH PLUMBING _
Address GAS PIPING
City Tel NO GAS VENT �f
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI c/.Tox HOT WATER HEATER
AND STATE THAT THE ABOVE la CORRECT AND AGREE To COMPLY PLUMBING FIXTURES 40 /
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING GAS TEST
I HEREBY CCRTIrY THAT I AM PROPERLY REGISTERED ND/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY 1N0 TA E Or /
CAL IFORMIA OR THAT 1M THE LE L OWNER O AND INT ID TO
REOIDE IN THE Aeove DeatRmCO IDCNn PROPE Y FINAL _ IL
-
SIGNATURE
OF PERMITTEE
PERMIT VALIDATION cit M o GASH
PLAN CHECK VALIDATION CN M O CASHED
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