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TEAEGT •CEEEIT 12.04 7
APPLICATION FOR PLUMBIN PERMIT
COUNTY OF LOS ANGELES
DEPARTNT OF COUNTY ENGINEER
BUIIIIG �51�FETY DIVISION 26 N Temple Cit Blvd
JO A LAM I OUNTY NOIN!!R ADDRESS DRESS
COLEMAN W JENKINS, SUPT OF BUILDING
LOCALITY Temple City
FOR APPLICANT TO FILL W Broadway
OSS
NUMBER FIXTURE OR ITEM EACH FEi
WATER CLo�r n owNee T. G. Schaub
BATH IRB 125 A�RESS 5526 N. Temple Cit Blvd
SHOWER 125 cm Temple Cit Tom' xo AT 63483
LAVATORY 125 CONTRACTOR Anthon Pools Inc
SINK 125 ADDRESS 5871 Firestone
DISHWAst� 125 CRY So Gate TEL No SP 32210
E 29 LAUNDRY TOB 125 REGI�STR VOCTORN NO l 0l C— COUNTYY
CLOTHES WASHER 125 DISTRICT CT NO GROUP ZONE PR ! BY
WATER HEATER 150 '5" o g D U L
GAR SYSTEM OUTLETS ISO INDUSTRIALWASTE APPROVAL d
OOn.LTa OVER S PER 8Y81EH[ 30DMMC710M RECORD 1041
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APPROVALS QATE. INSMCTON SIGNAWIN
PERMIT s 2 OO UNDER SLABWORK
ROUGH PLUMBING
TOTAL FEE 4 CC GAS PIPING
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS ARLICATION GAS VENT
AND STATE THAT THE AbV[ IS CORMCT AND AOSR TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLU MSINO
I HKRMS CERTIFY THAT I AM nmPERLY REGISTERED AND/OR PLUMBING FIXTURES
uCENEED AS REQUIRED EY LOS ANGELES COUNTY AND STATE OP GAS TEST
CALIFMIA OR THAT I AM THE LEGAL OWNER OI AMD INTENO TO
SEE M [AgGn RUED ERO[ ISL PTRTY UTILITY CO NOTIFIED
Ra T A IY 1
OF P[RMITTE FINAL
AMATION ROBERTA'w&r)
cK J M D CASH SUPERVISING MECHANICAL ENG R
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