HomeMy Public PortalAbout5470TEMPLE CITY BLVD_Plumbing 76A667 (CE-817)-8-71
APPLICATION FOR PLUMBING PERMIT
T BRANDY, COUNTY ENGINEER
COUNTY OF LOS ANGELES RVEY u
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM ® FEE _
OWNER
WATER CLOSET 1 75
MAIL
BATH TUB 1 75 ADDRESS
SHOWER 1 75 CITY TEL NO
LAVATORY 175 CONTRACTO
SINK 1 75 ADDRESS
DISHWASHER 1 76 - CITY TEL NO J�J33
CLOTHES WASHER 1 75 STATE r �/ LIC
SWIMMING POOL RECEPTOR 1 75 LICENSE NO CLASSC
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DISTaST NO I GROUP PEI O SSED BY
LAWN SPRINKLER SYSTEM 1 75 -15
WATER HEATER 1 75INDUSTRIA
WASTE APPROVAL 0
GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD U
OUTLETS OVER
5 PER SYSTEM 30 z
G
W
d
N
Z
Plan check fee See reverse
PLUMBING PERMIT ISSUING FEE a 3 00
TOTAL FEE
APPROVALS DATE INSPECTOR a SIGNATURE
Plan Check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel NO GAS VENT
HOT WATER HEATER
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND
STATE THAT THE Avove IS coxaett AND AGREE To COMPLY PLUMBING FIXTURES
wrtN ALL couxrr oR01 NA nc ea AND arwre uwa REGULATING
PLUMBING GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANo/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO
RESIDE In THE wGovE EecRleeO xEet ExnAL PR OPE Rrr FINAL
SIGNATURE
OF PERMITTEE
PERMIT VALID TI 01A . CA.N
PLAN CHECK VALIDA ION cK M D CAB. _ �,
LAP 0 4 2 073 APR 4.7 5 2