HomeMy Public PortalAbout5346TEMPLE CITY BLVD_Plumbing 76A667 CEK917 10 67 �} ,�
APPLICATIO FO PL MBI 6' PERMIT
COUNTY OF LOS ANGELES _
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVLSION DD�3
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUPT OF BUILDING LOCALITY -
FOR APPLICANT TO FILL IN PR NT OR TVPE "E T -
NUMBER FIXTURE OR ITEM EACH FEE
WATER CLOSET 1 50 OWNER
MAIL
BATH TUB 150 ADDRESS v
SHOWER 1 50 CITT TEL h O✓/
LAVATORY 1 50 CONTRACTOR
SINK 150 ADDRESS D
DISHWASHER 150 of, TEL NO
CLOTHES WASHER 150 SriCTEIFfr LIC
LICENSE NO /� CLASS
SWIMMING POOL RECEPTOR 150 DIYTRICT N ORO SONE PR D 0Y
LAWN SPRINKLER SYSTEM Z 00
3 a ,
U
WATER HEATER 150 RYDBSTRIAL
WASTE "FROVAL _ CD
GAS SYSTEM OUTLETS 150 RBpzcnO 1 RECORD U
OUTLETS OVER - w
5 PER SYSTEM 30 d
N
2
Plan check fee 25$6 of above See reverse
PLUMBING PERMIT ISSUING FEE S 2 00
TOTAL FEE
APPROVALS DAT! INSPECTOR 891GNATURE
Plan check applicant UNDER SLAB WORK - -
Name ROUGH PLUMBING _
Address GAS PIPING
GAS VENT
City Tel No HOT WATER HEATER --
1 H[R[RY ACKNOWLEDGE THAT 1 HAVE READ THIS ARLICATION
AND STAT[ THAT THE ABOVE IE CORRECT AND AORE[ TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND [TATE LAWS REGULATING GAS TEST
PLUM91N0
I HERESY CERTIFY THAT 1 AM PROPERLY R[GIST[R[D ANO/OR UTILITY CO NOTIFIED
UC[N= A[ REQUIRED 9Y LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INIAD TO
SENIOR IR THE ANDY 9CIII D RISI IALP RTY FINAL PER1111T VALIDATION cX I
SIGNATURE
JACK R ALLEN, SUPERVISING CHANICA O R
OF PERMITTEE '
M o CASH
PLAN CHECK VALIDATION cX M o CASH
LAC0 7 2 2 0 NOV 8 5 O 3 5 0^ g