HomeMy Public PortalAbout5819-5819 1/2TEMPLE CITY BLVD_Plumbing (2) APPLICATION FOR PLUMBING PERMIT
"CaUNTY 6F LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W: JENKINS. SUP'T. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN(PR NT OR TYPE) NEAREST
CROSS ST. i
NUMBER FIXTURE OR ITEM EACH F.EE
OWNER 00
WATER CLOSET 1.50 () MAIL
BATH TUB 1.50 ADDRESS e
SHOWER 1.50 CITY TEL. NO.
LAVATORY 1.50 CONTRACTOR z"
I_en
SINK 1.50 / 5-0 ADDRESS 7 klvc)
DISHWASHER 1.50 CITY P TEL. NO.41S66 �••
CLOTHES WASHER 1.50 STATE LIC
LICENSE NO. xg 5/ CLASS 3G
SWIMMING POOL RECEPTOR 1.50 DIBTRICT NO. GROUP ONE P CESSED BY
LAWN SPRINKLER SYSTEM 2.00
WATER HEATER 1.50' INDUSTRIAL PROVAL
- - O
GAS SYSTEM OUTLETS 1.50 INSPECTI CORD v
OUTLETS OVER LU
5 PER SYSTEM .30 ����G�j��. ti
Z
Plan check fee 25% of above. See reverse.
PLUMBING.PERMIT ISSUING FEE 8 2- 00
TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH-PLUMBING ,
Address GAS PIPING
GAS VENT
City, Tel. No. HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT 1 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 TEST
PLUMBING. '
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY-CO.-NOTIFIED
LRESIDE
SED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
ORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL
4�Q&
ATURE J /� JACK R. ALLEN, SUPER ISI HANICAL ENG'R.
PERMITTEE �N'
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
LACO 686OCT 15 5 D 655 to