HomeMy Public PortalAbout9421 BLACKLEY ST_Plumbing__ 76A667-CE9817 6-65 ,001'✓oe_-7—
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
JOHN A LAMBIIEBUILDING AND SCOUNTY EAFETY INGINVI OEER ADDRESBUILDINS 9421 Blackley
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY 'Semple City
FOR APPLICANT TO FILL IN NEAREST All%ssandro
LDN
NUMBER FIXTURE OR ITEM EACH FEE OWNER Robert M. Smith
WATER CLOSET $1 25 MAIL
BATH TUB 125 ADDRESS 9421 Blackley
SHOWER 125 CITY Temple City / TEL No 2.87-3670
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LAVATORY 125 CONTRACTOR Q(,vjV
SINK 125 ADDRESS
DISHWASHER 125 CITY TEL NO
STATE LIC
LAUNDRY TUB 1 25 LICENSE NO CLASS
CLOTHES WASHER 1 25 DISTRICT NO GR94L ZONE
PRO ESSED BY
WATER HEATER 150 sj o �D�
GAS SYSTEM OUTLETS 1 50 INDUSTRIAL n}
WASTE APPROVAL 0
OUTLETS OVER PER SYSTEM 30 INSPECTION RECORD U
0
G Lu
W
D.
N
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APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2 CIC UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN,THE ABOVE RIB D RESPENTIAL PROP r UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL
(CK / M 0 ION
CK M O CASH
LALO_2 5 9 -3' JUN 9 5 D 1 6.25-