HomeMy Public PortalAbout5032TEMPLE CITY BLVD_Plumbing 70AEE7 CE4817 10 ET �I/ 17
APPLICATION FOR PLUMBING PERMIT U
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVLMION m"MG o J Z
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUP T OF BUILDING LOCALI77 1
FOR APPLICANT TO FILL IN PR NT OR TYPE CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET 1 50
MAIL
BATH TUB 1 50 ADDRESS
SHOWER I42
50 CITY NO
LAVATORY 1 50 CONTRA
SINK 150 ADDRESS
DISHWASHER 150 CITY
CLOTHES WASHER 1 50 STAT LIC p
LICENSE N9,10 CLAS '
SWIMMING POOL RECEPTOR 1 50 DISTRICT NO GROUP ZONE PROCESSED BY
LAWN SPRINKLER SYSTEM 700 S.Q
WATER HEATER 150 MDreS AL
APPROVAL
GAS SYSTEM OUTLETS 1 50 INSPECTION RECORD
OUTLETS OVER JO 1
5 PER SYSTEM
N
Plan check fee 25% of above See reverJC�PLY
PLUMBING PERMIT ISSUING FEE2 00
TOTAL FEE
APPROVALS DATE INSPECTOR a SIGNATURE
Plan check applicantUNDER SLAB WORK
Name ROUGH PLUMBING _
Address GAS PIPING
GAS VENT
City Tel NOHOT WATER HEATER "
1 MEMORY ACKNOWLEDGE THAT 1 HAVE HEADLICATION
AND STAT[ IN
AT THE AEOVE lE CORRECT AND CO PLY PLUMBING FIXTURES
WITH ALL COUNTY ONDINANCES AND STATE ULATING GAS TEST
PLUNaINO
IHEREBY CK"IFY THAT I AM PRO"RLY R AND/OR UTILITY CO NOTIFIED
LIUNEED AS REQUIRED BY LOS ANGELES COURATE OFCALIFORNIA OR THAT I AN THE LEGAL OWNERTORESIDE IN THE ASOV[O[1CRIUD IESIDENrI FINAL
SOP ATURE• — JACK R ALLEN, SUPERVISING
M&4HANICAL ENG'RPERM -
PERMIT VALIDATIONC -C; 5 M O CASH
PLAN CHECK VALIDATION CK M D CASH - ��
LA',i8 3 7 3-� FEB11 5 D 5,00"