HomeMy Public PortalAbout5116 DALEVIEW AVE_Plumbing__ 76P.667-C£61712/59 TEMPLE CITY
APPLICATION FOR PLUMBING PERMIT
COUNTY OF
CUNYNGINEER
s..
BUILDING IND SAFETYIVISION BUILDING
JOHN A. LA BIE, COUNTY NGINEER ADDAESS �/ _
WILLIAM A. JENSEN. SUPT OF Bm LDING
I LOCALITYo
FOR APPLICATO FILL IN
NTNEAREST
CROSS ST.' ! U
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET NAIL
ADDAESS
BATH TUB
CITY TEL. NO.
SHOWER
LAVATORY CONTRAC R -�t
SINK ADDRESS
DISHWASHER CITY, e;L TEL. NO.
CONTRACTOR' STATE El
LAUNDRY TUB REGISTRATION O. COUNTY ❑
CLOTHES WASHER P
NO. d GROUP Z EESSEDu BY
z
WATER HEATER Isu`'"L.
GAS SYSTEM OVALp.INSPECTION RECORDi1J�gI
ex
D1.00 PER ITEM
R FIXTURE $ [S.
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK p� .q
TOTAL FEE 7 r{� ' ROUGH PLUMBING v _ &L
GAS PIPING r k /
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
_ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
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 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PR0 ETY. - - UTILITY CO.NOTIFIED If
SIGNATURE �(Jt_. i
OF PERMITTE FINAL �Lv
®. VALIDATION ROBERT A. WOOD.
cE.
U.0. CASH SUPERVISING MECHANICAL ENG'R
Lico3 5 1 3 JUL 12 5 B 1 Q,Q 0 f