HomeMy Public PortalAbout5530-5605TEMPLE CITY BLVD_Plumbing j' 76AB5-ICE SIV-4/72 Yom,
APPLICATION FOR PLUMBING PERMIT !�
COUNTY OF LOS ANGELES - fl
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
MAKE CHECKS PAYABLE TO ADDRESS 5584-86-88 N.Temple City Bvld.
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAgEST
CROSS ST
NUMBER FIXTURE OR ITEM ® FEE
WATER CLOSET 1 75 OWNER Ron McClosliy
3 BATH TUB 1 75 ADDRESS 870 Eadt Mariposa
SHOWER 1 75 CITY TEL NO 79
LAVATORY 1 7$
CONTRACTOR '
SINK 1 75 ADDRESS x,265 North Baldwan Avenue
3 DISHWASHER 1 75 CITY El Monte TEL NO 8
_6 CLOTHES WASHER 1 75 T51ND
E 231741 LIC C36
NSE NO CLASS
SWIMMING POOL RECEPTOR 1 75
ISTRICT NO GROU Z NE FR BY
LAWN SPRINKLER SYSTEM 1 75 0
WATER HEATER r 1 75 E 4PPROVAL
GAS SYSTEM OUTLETS 1 7S INSPECTION RECORD
OUTLETS OVER 30
5 PER SYSTEM '
x
Plan Check fee See Reverse
PLUMBING PERMIT ISSUING FEE S 3 00
TOTAL FEE
APPROVALS DATE misPYcT,4R n eIrNATU RL
Plan Check applicant UNDER SLAB WORK t
Name ROUGH PLUMBING )
Address GAS PIPING
City Tel No GAS VENT
HOT WATER HEATER
1 HEREBY ACKNOWLE04M THAT I HAVE READ THIS APPLICATION
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING GAS TEST
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY OS ANGELES COUNTY AND STATE OF
CALI IG IWA OR THAT I AM E LEO L OWNER OF, AND TEND TO
RESIDE IN THE ABOVE DES E R NTIAL PI PER FINAL
SIGNATURE
OF PERMITTEE
PERMIT VALIDATLON CK M G CASH
PLAN CHECK VALIDATION C M 0 CASH
Lrr,o Q o 9 5 ij su 28 5 D 39.75-
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