HomeMy Public PortalAbout4902TEMPLE CITY BLVD_Plumbing (2) 009167 ,;; APPLICATION FOR PLUMBING PERMIT
16ihMON OF BUILDING AND SAFETY
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County of Laa�Ahn eer '
BUILDING
VIM J FOX COUNTY ENGINEEFf ADDRESS )~`
CASEATT D GRATIN BOF T of am,Di.
FOR APPLICANT TO FILL IN NEAREST c.J G
OWNER V , d' DISTRICT NO GROUP 1 ZONE AuoT MR INArtttlam
MAIL _�
ADDRESS
INOUSTRIAL
I WASTE APPROVAL
PLUMBER ! PLAIC
G INSPECTION AECOSD
ADORESS t 0 S S 1
CITYts - _ T NO
g:E
LICENSE NO Y F_
NUNEER TYPE OF FIKTORE OR ITEM FEE
WATER CLOSET (TOILf
BATH TUB
SHOWER
LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER
a/
TOTAL NO 060 APPROVALS
DATE INSPECTOR S SIGNATURE
GAS SYSTEM_ OUTLETS ® 1 00
UNDER SLAB WORK
WATER HEATER 100 11
ROUGH PLUMBING �I �
PERMIT t I GAS PIPING
_ TOTAL FEE _ GAS VENT
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APP CATI N HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY '0 lC
WITH ALL COUNTY ORDINANCES AND !TATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST Q G S
LICENSED A! REQUIRED BY L09 ANGELES COUNTY AND STATE OF UTILITY CO NOTIFIED
IL
CALIFORNIA OR THAT 1 AM T E LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PR TT
SIGNATURE
OF PERM ITTEE FINAL S a-
MEE= 1V
WILLIAM J FOX COUNTY ENGINEER VALIDATION
T,03892n KRY18 3 - 7.00 0
ST 14 04aA a GGA. ,
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