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6 APPLICATION F&P PL MB1N PERMIT y
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER TEMPLE CITY
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO BUILDING 5021 NO AGNES
ADDRESS u e__
HARVEY T BRANDT, COUNTY ENGINEER LOCALITY TEMP E C
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM @ FEE
2 0o OWNER FOLTZ, ARTHUR
WATER CLOSET MAIL
BATH TUB 200 ADDRESS ME ABOVE
SHOWER 2 00 CITY TEMPLE CITYTEL NO 2T5—T573
LAVATORY 2 00 CONTRACTOR TRANE HCC
SINK 200 ADDRESS 2034 NO PECK RD
DISHWASHER 200 CITY FL MONTE TEL NO 579-7982
CLOTHES WASHER 2 00 STATE LIC
SWIMMING POOL RECEPTOR 2 00 LICENSE NO CLASS
DISTRICT NO IGROUP ONE PRO ESSE BY
LAWN SPRINKLER SYSTEM 2 00 1DO iI
WATER HEATER 200 INDUSTRIAL
WASTE APPROVAL
1 GAS SYSTEM OUTLETS 2 00 3 00 INSPECTION RECORD U
OUTLETS OVER
5 PER SYSTEM 30
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U
W
CL
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Plan check fee See Reverse
L
LUMBING PERMIT ISSUING FEE $ 43 �B
TOTAL FEE 7 50
APPROVALS DATE INSPECTOR 9 SIGNATURE
check applicant UNDER SLAB WORK
ROUGH PLUMBING
ess GAS PIPING
Tel NO GAS VENT
HOT WATER HEATER
EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ING GAS TEST -
EREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
ED AS REOUI RED BY LOS ANGELES COUNTY AND STATE OF
RNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TOh�
IN THE ABOVE DESCRIBED RESIDENTIAL PAOPERTY FINAL v
ATU RE SPERMITTEE ` 2
PERMIT VALIDATION C" M o CASH
PLAN CHECK VALIDATION CK M o CASH
661C"-'wY 3 5 D 75QAb,