HomeMy Public PortalAbout5029TEMPLE CITY BLVD_Plumbing (2) 7BA667 (CE-617) - 5/75
APPLICATION FOR PLUMBING- PERMIT"
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TOn1, T ADDRES BUILDING > �T f
E
HARVEY T BRANDT, COUNTY ENGINEER _
LOCALITY3
FOR APPLICANT TO FILL IN (PRINT OR TYPEI NEAREST
CROSS ST _
NUMBER FIXTURE OR ITEM O FEE
WATER CLOSET 1 75 4 I OWNERAIL
BATH TUB 1 75
ADDRESS
SHOWER 1 75 CITY r 1~TEL NO-
LAVATORY i 75 CONTBACTO QO 7
SINK 1 75 ADDRESS
DISHWASHER 1 75 RO11 Y CITY 11j 0 TEL NO FI �r 11
CLOTHES WASHER 1 75 _ IIS
STATE' LIC
SWIMMING POOL RECEPTOR 1 75 LICENSE•NO 31c CLASS
DIS_TRIv Ng GR UP MINE CESSEO BY
LAWN SPRINKLER SYSTEM 1 75 I 5gg �pI L �7
WATER HEATER 1 75 IND TAPAPROVAL
WAS
GAS 5 E O 1 75 - -MPECIIONAWCORD c�
OU ET VER
5 TEM 3O 1 p
D LIA
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE
APPROVALS DATE INSPECTOR S SIGNATURE
Plan Check applicant DER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City _ Tel No GAS VENT
HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCE! AND STATE LAWS REUULATINO
PLUMBING GAS TEST
I HEREBY CERTIFY T AM PROPERLY GISTERED AMD/OR UTILITY CO NOTIFIED
LICENSED AS REOUIRI BY OS •N S EL LS C TY AND STATE OF
CALIFORNIA OR THAT NE LEGAL OW F. AND INTEND TO
RESIDE IM THE ADDY IB RlBIOE ROPERTY FINAL
SIONATU RE
OF PERM E
PERMIT VALIDATION (CK 0 CASH
PLAN CHECK VALIDATION CK M 0 Cu"6 5w$EP 11 5 4_ .7 5 A96
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