HomeMy Public PortalAbout5442 CLOVERLY AVE_Plumbing__ 76A667 (CE-617)-4/72 CITY OF TEMPLE CITY
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER 404 57
BUILDING AND SAFETY DIVISION
BIJILIIIG
MAKE CHECKS PAYABLE TO ADDRESS 5442 Cloverly Ave.
HARVEY T BRANDT, COUNTY ENGINEER
BU'
LOCALITY Temple Cit
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST Lower Azusa & Temple
NUMBER FIXTURE OR ITEM @ FEE O
OWNER
WATER CLOSET 1 75
Edward qiqda
MAIL
BATH TUB 1 75 ADDRESS e
SHOWER 1 75 CITY TEL NO
LAVATORY 1 75 CONTRACTOR GENERAL INSTALLATION CO.
SINK 1 75 ADDRESS 6558 WEST BLVD.
DISHWASHER 1 75 CITY Los Angeles TEL NO PL 3-2541
CLOTHES WASHER 1 75 STATE LIC
LICENSE NO C 36 151839 CLASS
SWIMMING POOL RECEPTOR 1 75
DISTRICT NO GROUP E FR ESSE BV
LAWN SPRINKLER SYSTEM 1 75 � �! �
L / 1
l WATER HEATER 1 75 l 75INDUSTRIAL
WASTE APPROVAL
a
GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD C:)
OUTLETS OVER
5 PER SYSTEM 30 Ready for Inspection Now o
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WATER SOFTENER uC.Z�a
a.
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE 4 75
APPROVALS DATE INSPECTOR 5 SIGNATURE
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
ANO 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 , I
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED RESIDEN P PER FINAL
SIGNATURE • II
OF PERMITTEE
PERMIT VALIDAT cK M o CASH
PLAN CHECK VALIDATION CK M 0 cns�1 1� OV 5 0 ^�� 5