HomeMy Public PortalAbout5470TEMPLE CITY BLVD_Plumbing (2) r
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO BUILDING �FqY!V�7-zp
ADDRESS /l
HARVEY T BRANDY, COUNTY ENGINEER LOCALITY ptE FOR APPLICANT TO FILL IN (PRINT OR TYPEI NEAREST
CROSSSTNUMBER FIXTURE OR ITEM ® FEEWATER CLOSET 1 75 OWNER
BATH TUB 1 75 ` ADDMAIL Au
RESSSHOWER 1 7s yE TEL LAVATORY 1 75 CONTRACTOR c4 /SINK 1 75 ADDRESS o3 /�1218 /9A 4"
DISHWASHER 1 75 CITY 7`CTEL CLOTHES WASHER 1 75 a/SWIMMING POOL RECEPTOR 1 75 LIENSE NO S CLASS /
DIfRICT,NO GROUP ZONE PR E E
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LAWN SPRINKLER SYSTEM 1 75 /1 , OLL�
WATER HEATER 1 75 WASTE APPROVAL
GAS SYSTEM OUTLETS 1 75 73- INSPECTION RECORD c
OUTLETS OVER CC
5 PER SYSTEM 30 - CD
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEES 3 00
TOTAL FEE
APPROVALS DATE Ina PECTan s SlcuArmc
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel NOGAS VENT
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I "AVE READ TXIB APPLICATION
ANO STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR UTILITY CO NOTIFIED
LICENSED AS REOUI RED BY LOS ANGELES COUNTY AND STATE OI
CALI FORXIA OR THAT AM THE LEGAL OWNER OF AND CND T
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPER % FINAL
SIGNATU RE
OF PERMITTEE
PERMITVALID T CK M .0
PLAN CHECK VALI TION CA M D CASH
t A(r 0 4 2 173 APR 6 D ,75