HomeMy Public PortalAbout5038TEMPLE CITY BLVD_Plumbing 75A667 (CE-8117)-8-71
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER Q
BUILDING AND SAFETY DIVISION BUILDING
ABU
DDRESS
LOCALITY �(✓{...1� •-r'
FOR APPLICANT TO FILL IN (PRINT OR TV PEI NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM ® FEE
OWNER 7
WATER CLOSET 1 75
MAIL
BATH TUB 1 75
ADDRESS 10 f, Y
SHOWER 1 75 CITY a404
TEL NO T — V
LAVATORY 175 CONTRACTOR
SINK 1 75 • ADDRESS C _
DISHWASHER 1 75 CITY �� TEL NO 6
CLOTHES WASHER 1 75 STATE LIC
SWIMMING POOL RECEPTOR 1 75 LICENSE NO Q CLASS—�
DISTRICT NO GROUP ZONE P CESSED BY
LAWN SPRINKLER SYSTEM 1 75 ICS 0 O
WATER HEATER 1 75 •TaplI/ O
WASTE APPROVAL d
GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD V
OUTLETS OVER 30
5 PER SYSTEM
O
U
d
N
/z
Plan check fee See reverse 01
PLUMBING PERMIT ISSUING FEE S 3 00 Aen
TOTAL FEE QV/2 LST 1-6� e41 —L
APPROVALS DATE INSPECTOR S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
A�feSS GAS PIPING
City Tel No ` GAS VENT
1 HEAE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLI GAT'ON HOT WATER HEATER Z
AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES ,Y
WITH ALL COUNTY OROINANCE9 AND STATE LAWS REGULATING GAS TEST
PLUMBING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR UTILITY CO NOTIFIED
LICEN310 AL REQUIRED BY LOS ANGELES COUNTY AMD STATE OF ,
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF ANO INTEND TO
RESIDE IN THE ABOVE DESCRIBED RESIOGN71AL PROPERTY FINAL
i
OF PERMITTEE
PLAN CHECK VALIDATION cK M o CASH PERMIT VALIDATION o ASH
LAGo0701 3J" 235 D 4.75 o
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