HomeMy Public PortalAbout5312TEMPLE CITY BLVD_Plumbing Ta Aa6Tnlc Ea17AI B/TB C
~ ' APPLICATIO FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO BUILDING CI I2- -rP l ' DA)
ADDRESS tJ✓ y 61
HARVEY T. BRANOT, COUNTY ENGINEER LOCALITY �" (� •-�
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM ® FEE
WATER CLOSET OWNER JV �MAIL //77BATHTUB ADDRESS 5312- P eCSHOWER CITY ~_ qC TyEL NLAVATORY CONTRACTORJJ-V ^COA3,StkWSINK _� ADDRESS 9� 3CIWA$HE CITYd) f LO �7 TEL NCLOTHES WASHER STATELCENSE NO IO 3 / CLSWIMMING POOL RECEPTORDISTRICT NO GROUP ONE
LAWN SPRINKLER SYSTEM
WATER HEATER IN
WASTE AFPRDUSTRIALOV[[A�'L
GAS SYSTEM OUTLETS INSPECTION RECORD
OUTLETS OVER Q
S PER SYSTEM U
1 Q
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N
Z
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE 8
TOTAL FEE
APPROVALS GATE INSPECTOR s ai�xeru RE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel No GAS VENT
HOT WATER HEATER
I HEREBY THAT
ACKNOWLEDGE THAT I NAYS READ THIS APPLICATION
AND BALL THAT THE ABOVE IS
CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES '
WITH ALL COUNTY ORDINANCES •MD STATE LAWS REGULATING
PLUM BI NO GAS TEST Z.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY LOS A GEL[! COUNTY AND STATE OF
CALIFORNIA OR THAT AM THE LE L OWNER OF AND INTEND TO ,(
RESIOE IN THE ABOVE DE RISE RE DENTIAL PROPERTY FINAL _
SIGNATURE
OF PERM( E
PERMIT VALIDATION cN M 0 CASH
PLAN C VALIDATION cK M cABx '
038E'O.$Ep 2 5 e 1650 Lx .
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