HomeMy Public PortalAbout5537TEMPLE CITY BLVD_Plumbing (2) ' 7^667 ICI= bin-un
• APPLICATION FOR P�LUBING PgRMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO ABUIDDLDRESSING
HARVEY T BRANDT, COUNTY ENGINEER LOCALITY
Im o4v (2t x4
FOR APPLICANT TO FILL IN (PRINT OR TY PEI NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM • FE
WATER CLOSET 1 75 _ _OWNER
3JO MAIL
BATH TUB 1 75 ADDRESS 4{ G
SHOWER 1 75 7.r CITY TEL NO
LAVATORY 1 75 -d CONTRACTORof y 00 4CT D
SINK 1 75 Jam^ ADDRESS
DISHWASHER 1 75 CITU�C N &JIL NOa 0,0
if CLOTHES WASHER 1 75 Jf STATELIC
S
SWIMMING POOL RECEPTOR 1 75 LICENSE NO CLASS -r
QGflf]LIF CESSED BY
LAWN SPRINKLER SYSTEM 1 75 C�iI/+I LQO jSTRICT NO P `1 y
WATER HEATER 1 75 J3" W"AJSUSTE TAROMOVAL p,•
GAS SYSTEM OUTLETS 1 75 7.S' 1 INSPECTION RECORD
OUTLETS OVER 30 O [C
5 PER SYSTEM
x
Plan Check lee See Reve,ae
PLUMBING PERMIT ISSUING FEE S 5 00
TOTAL FEE
APPROVALS DATE INSPECTOR a aiax Aru Rc
Plan check applicant UNDER SLAB WORK
Name Q//GG `,' ROUGH PLUMBING Q
Address 79 3004AA.11192-a GAS PIPING
GAS VENT
City N 9R LTB( NO D•OG� HOT WATER HEATER
I HEREBY ACKNOWLEDGE TN T I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS AS TEST
IHEREBY CERTIFY THAT LOAM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REOU[RED BY OS AN GELCS COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO I 7
RESIDE IN THE ABOVEDES IBED SIDENTIAL P ERTY FINAL /
SIGNATURE
OF PERMITTEE PERMIT VALI ATION CK I M O CASH
PLAN CHECK I �DATION CK M O CAC, 04 9;4 OCT 2 5 D 2 050^' Q
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