HomeMy Public PortalAbout5728 A-ETEMPLE CITY BLVD_Plumbing DEPARTBDT.I.1T OF COUNTY ENGINEER PLUMBING 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES ,Bu1LDINo
WILLIAM L FOX, CoumT ENGINEER 4 [
FOR APPLICANT TO FILL IN LOCALITY C,
BUILDING2 NEAREST
ADDRESS J-72-e- //• � CROSSST
LOCALITY DISTRICT NO GROUP I,�ZONE PERMIT NO
NEAREST �/� �T � � _ O Y-3
CROSS ST wZI(/80•EO�"' RECEIVED BY Rndy Tw InipwGEn DATE ISSUED
OWNER /[
tlAIL INDUSTRIAL
ADORE88 ,j"J 1 J(- �i>< WASTE APPROVAL
CITY T C - TEL NO INSPECTION RECORD
PLUMBER �r � T
ADDRESS 7/JAG.• —/}
CITU dd�QIW TEL.4006;p
A
LICENSE NO Z C-34 COUNTY J
PERMIT FEES =
iUM"R T m OI fl%T " OR ITEM K[ O
WATER CLUSET(TOILET) ® OAO 8 rc
0
BATH TUB 0 080
SHOWER ® OMI
LAVATORY(WASH BASIN) 0 080
KITCHEN SINK 0 0 MI O
LAUNDRY TUB OR TRAY 0 OMI
SLOP SINK ® 0 SO
FLOOR SINK 0 OMI
FLOOR GRAIN ® 000
DISHWASHER @ 080
DRINKING FOUNTAIN • 080
URINAL a 080
GAB SYSTEM _ _OUTLETS 0 IAO
WATER HEATER ® 100
MISCELLANEOUS
u/ APPROVALS
DATE INSPECTORS SIGNATURE
UNDER SLAB WORK
PERMIT f I I DO ROUGH PLUMBING
TOTAL FEE Z 160 GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- OAB VENT
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE HOT WATER HEATER'-
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING PLUMBING FIXTURES
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AHD/OR LICENSED AS REQUIRED BY LOB ANGELES COUNTY GAB TEST
AND STATE OF CALIFORNIA OR THAT I AN THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED/RESIDENTIAL PROPERTY UTILITYCO NOTIFIED
OF
SIGNATURE
T!!
FINAL 1 �1 ►`.
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