HomeMy Public PortalAbout5132TEMPLE CITY BLVD_Plumbing 76AGO7 ICE-8171- 5/73 2'
APPLICATION FOR PLUMBING PERMIT'
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUI DING
IIIA KE CHECKS PAYABLE TO ADDRESS ---/11 /E
HARVEY T BRANDT, COUNTY ENGINEER LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE( NEAREST /
NUMBER FIXTURE OR ITEM ® FEE CROSS ST IL
WATER CLOSET _ 1 75 = __ _OWNEfl
i
- MAIL
BATH TUB 1 75 ADDRESS-
SHOWER 1 75 CITY TEL NO,,2
LAVATORY 1 75 CONTRACTOR III'I 1,&TA /I&,&
SINK 1 73 ADDRESS U o ,eIQAl� �-
DISHWASHER 1 75 CITY r1;m �(v TEL NO CvL(�a� O
CLOTHES WASHER 1 75 STATE ..( (J' LIC
6 `
SWIMMING POOL RECEPTOR 1 75 LICENSE NO .4/1 CLASS
DI TRICT NO GROUP 'lE PROCESSED BY
LAWN SPRINKLER SYSTEM 1 75 �JS•{pf�LN I
WATER HEATER 1 75 WASTE APAPRIOVAL y
GAS SYSTEM OUTLETS 1 75
INSPECTION RECORD
OUTLETS OVER 1
' S PER SYSTEM BO
H
W
i CL
Plan Check lee Sae Reverse
Y PLUMBING PERMIT ISSUING FEE S 3 00cc
TOTAL FEE d
APPROVALS DATE INSPECTOR a 51axArD+[
Plan check applicant UNDER SLAB WORK
Name I ROUGH PLUMBING
Address GAS PIPING
City Tel NO GAS VENT
HOT WATER HEATER — y
I HEREBY ACKNOWLEDGE THAT I HAVE READ "IS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMeIxa GAS TEST
1 HEREBY CERTIFY THAT I AM PROPERLY RE013TERED AND'OR
UTILITY CO NOTIFIED
LICENSEDAS REOUIRED BY L05 ANGELES COUNTY AND STATE OE • ,
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED RnE5IDENTIpL PROPERTY FINAL
SIGNATURE
OF PERMITTEE
PERMIT VALIDATION cK M o GASH
PLAN CHECK VALIDATION CK M o CASH/
6 2 ZkJAN 29 T 5 D 1' 4.7 Jr A�Ic
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