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HomeMy Public PortalAbout5520TEMPLE CITY BLVD_Plumbing 76AI67A (ea 8110) •A/TT APPLICATION FOR PLUMBING PERMIT BUILDING AND SAFETY DIVISION ENO FOR APPLICANT TO FILL IN IPRINTOR TYPEI BUILDING ^- NUMBER FIXTURE OR ITEM O FEE _ 1 WATER CLOSET LOCALITY c . BATH TUB NEAREST /�� ¢ .f CROSS ST �C-W SHOWER OWNER LAVATORY MAIL ADDRESS SINK CITY DISHWASHER CONTRACTOR pon CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTORCITY ,AIyL LAWN SPRINKLER SYSTEMSTATE WATER HEATER LICENSE NO rj O GAS SYSTEM OUTLETS DISTRICT�O o GROUP ZQtJ� DBV SO PER SYSTEM INDUSTRIAL C, �, ci WASTE APPROVAL INSPECTION RECORD CD � y� Plan check fee PLUMBING PERMIT ISSUING FEE E TOTALFEE Plan check applicant Nome I S � APPROVALS DATE INSPECTOR S SIGNATURE l UNDER SLAB WORK 5Z2AddressreP L..� U NARK1, ROUGH PLUMBING CIry Tel No 5 I GAS PIPING I MREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT TMT THE ARM IS CORRECT AND AGREE TO COMPLY WTTII ALL COUNTY ORDINANCES AND STATE TAWS REGULATING PLUMBING HOT WATER HEATER I HEREBY CERT6Y THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURE .5�.. REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORMW OR THAT IAM THE GAS TET LEGAL OWNER OF AMD INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PACI UTILITYCO NOTIFIED SIGNATURE OP PERMITTEEAienFINAL PLAN PERMIT VALIDATION cK M D CASH POLICY HOLDER: 0 9 2 JAN 13 5 D_ 1 3.5 0 .t;6 POLICY NUMBER: