HomeMy Public PortalAbout5271 1/2-23-23 1/4-23 1/2-25-25 1/2TEMPLE CITY BLVD_Plumbing (2) TaneBT ccE-ern - enB
APPLICATION FOR PLUMBING PERMIT-
COUNTY
ERMIT- T
DEPAROTMEN�T OF LOS
ENGINEER
` BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE BUILoiPc TO T ADDRESS
HARVEY T BRANDT, COUNTY ENGINEER LOCAL
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEARE
NUMBER FIXTURE OR ITEM ® FEE CROSS ST
WATER CLOSET 1 75 - . OWNER
MAIL
BATH TUB 1 75 -ADDRESS
SHOWER 1 75 CITY TEL NO
LAVATORY 1 75 CONTRACTO `
SINK 1 75 ADDRESS
DISHWASHER 1 7S
CLOTHES WASHER 1 75 1 LITA LIC
C NS NO
DISTRICT NO�D GG CLASS& 13
SWIMMING POOL RECEPTOR 1 75
PROC S
LAWN SPRINKLER SYSTEM 1 75 p GROUP ZONE ED BV
WATER MEAT 1 75 r 14ASTE A�APhOVAL
GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD
UTLETS OVER
5 PER SYSTEM 30 - DC
O
W
LL
t y
Z
PIED check fee See Reverse
PLUMBING PERMIT ISSUING FEE S 3 00
TOTAL FEE S
APPROVALS DATE INSPECTOR n SIGNATURE
Plan Check applicant UNDER SLAB WORK '
Narne, ROUGH PLUMBING -
Address GAS PIPING
City Tel NO GAS VENT
HOT WATER HEATER
_ 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUM NG GAS TEST
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AMD/OR UTILITY CO NOTIFIED
LICENSED AS REOUIREO BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RES DE IN THE ABOVE DESCRIBED R[SIDEMTI PROPER FINAL _ ,
SIONATU RE
OF PERMITTE
PERMIT VALIDATIONCK M D ,CASH
PLAN CHECK VALIDATION CK M 0 CASH
6 0 4Y2JAN 26 5 D 4,7 5 Azo
J�