HomeMy Public PortalAbout5828TEMPLE CITY BLVD_Plumbing 76A667 (CE-817)-4/7.E
APPLICATION FOR PLUMBING PERMIT
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COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: FADDRESS
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HARVEY T. BRANDT, COUNTY ENGINEER
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FOR.APPLICANT TO FILL IN (PRINT OR TYPE) . r
NUMBER FIXTURE OR ITEM @ FEE•
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OWNER WATER CLOSET 1.75 / ADDRESS
BATH TUB 1.75
SHOWER 1,75 CITY XC4ewl TEL. NO.O? 0%7
LAVATORY 1.75 CONTRACTOR C
SINK 1.75 ADDRESS
DISHWASHER 1.75 CITY M 66- 61-FI4TEL.-NO. p(,-0Sb'S
CLOTHES WASHER 1.75 STATE g?7;2 3 b CLIC
LASS
LICENSE NO.
SWIMMING POOL RECEPTOR 1.75
LAWN SPRINKLER SYSTEM 1.75
DISTRICT NO. GROUP ZONE PROCESSED$Y
/ WATER HEATER 1.75 j. 9S INDUSTRIAL C_ y
WASTE APPROVAL O.
GAS SYSTEM OUTLETS 1.75 - INSPECTION RECORD cC>.�
OUTLETS OVER
5 PER SYSTEM .30
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE'S 3 00
TOTAL FEE
APPROVALS DATE PECTOR'S eIG URE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. No. GAS VENT
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THEABOVE 15 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. GAS TEST
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO y
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY FINAL
SIGNATU RE
OF PERMITTEE PERMIT VALIDAT)O
M.O. CASH
PLAN CHECK VALIION CK. M.O. CASH " /
n(',� 0 1. 9 973. 14AR 2 7 5 D 8.2 5 N CQ