HomeMy Public PortalAbout5318TEMPLE CITY BLVD_Plumbing (2) 76"TA I aI�m10I -4/77
APPLICATION FOR PLUMBING PERMIT
BUILDING AN AFETY DIVISION
FLAVATORY
CANT TO FILL IN(PRINT OR TYPE( BUILDING Tm e I v ,
FIXTURE OR ITEM FEE ADDRESS
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NEARESCROSSST —OWNER d ,MAILADDRESS CITY e Jj pilTEL NO
DISHWASHER CONTRACTOR
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CLOTHES WASHER 8 4
ADDRESS �
SWIMMING POOL RECEPTOR
CITY OY a TEL NO
(AWN SPRINKLER SYSTEM
STATE LIC
WATERHEATER- --___ _ _ __ L
ICENSE A54
GAS
Si``SYSTEM OUTLETS DISTRICT NO UP E P SSED BY o�
SO PERSSTEM INDUSTRIAL ! J, S
WASTE APPROVAL C
INSPECTION RECORD CDD
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Plan check fee
PLUMBING PERMIT ISSUING FEE$
TOTALFEE
Plan check applicant
Name APPROVALS DATE INSPECTOR S SIGNATURE
UNDER SLAB WORK
Address ROUGH PLUMBING —�
City Tel No GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCATION AND STATE GAB VENT
THAT THE ABOVE O CORRECT AND"REE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AID/OR LICENSED AS PLUMBING FIXTURES S
REQUIRED BY LOS ANGEM COUNTY AND STATE OF CAUFORNM OR THAT I AM THE GAS TEST —i
LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBBD AESIDFATLAL
PROPERTYUTILITY CO NOTIFIED
P
SIGNATURE `
OPERMITTEE FINAL
PLAN CHECK VALIDATION CK MY PE ITV I ^TION