HomeMy Public PortalAbout5827-5827 1/2-5729TEMPLE CITY BLVD_Plumbing 76A667.(CE-817)-F73
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: BUILDING
ADDRESS,-
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE! NEAREST
NUMBER FIXTURE OR ITEM @ FEE CROSS ST.
OWNER
WATER CLOSET 1.75'
MAIL -
BATH TUB 1.75 ADDRESS
SHOWER 1,.75 CITY TEL. NO. r
LAVATORY 1,15 CONTRACTOR
SINK 1+.75 ADDRESS
DISHWASHER 1;,75CITY f'" TEL. NO.
CLOTHES WASHER 1175 STATE LIC
LICENSE NO. CLASS
SWIMMINGIPOOL RECEPTOR 1.75
DISTRICT NO. GROUP ZONE PROCESSED BY
LAWN SPRINKLER SYSTEM 1.75
WATER HEATER 1,75a
NDUSTRIAL p
p.; WASTE APPROVAL v
GAS SYSTEM OUTLETS 1:'75 . INSPECTION RECORD J
OUTLETS OVER
5 PER SYSTEM 30 W
O
W
F—
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL^FEE r`F
APPROVALS DATE INSPECTORS SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. No. GAS VENT
HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT 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
PLUMBING. GAS TEST
-I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES-COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL
F, .
SIGNATU RE
OF PERMITTEE_��, •� -�" ,� '
PERMIT VALIDATION CK. M,O. CASH
PLAN CHECK VALIDATION CK. M.O/,... CASH