HomeMy Public PortalAbout6166-6168 ROSEMEAD BLVD_Plumbing__ 78AIIA'(CE B878) -4/77
-APP, LIGATION FO PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING J
NUMBER FIXTURE OR:I"TEM ® FEE ADDRESS (p
WATER CLOSET 'LOCALITY
NEAREST
Q BATH TUB CROSS ST.
SHOWER fl ell OWNER °R
LAVATORY MAIL-
ADDRESS
SINK CITY TEL.NO.
DISHWASHER CONTRACTOR w L
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR ys
CITY TEL.NO.
LAWN SPRINKLER SYSTEM
STATE � LIC.
WATER HEATER M, LICENSE NO: CLASS °
GAS SYSTEM OUTLETS DISTRICT NO. G UP ZONE PRO ED BY
OUTLETS OVER. C2,
� �3 � O
5 PER SYSTEM INDUSTRIAL c.a
WASTE APPROVAL OC
INSPECTION RECORD
W
cn
. Z
Plan check fee
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE
Plan check applicant
Name APPROVALS DATEj INSPECTOR'S SIGNATURE
UNDER SLAB WORK S S
Address. ROUGH PLUMBING
City Tel.No. GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THATTHE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY LOS ANGELES CO AND STATE OF CALIFORNIA OR THAT' AM THE GAS TEST .
LEGAL OWNER OF.AND INT T RESIDEI IN THE ZABOVED [BED RESIDENTIAL 79
PROPERTY. UTILITY CO.NOTIFIED
- v
SIGNATURE y^ -
OF PERM ITTE FINAL °D
PLAN 696VALIDATION 4v M.D. CASH PERMIT VALIDATIO ♦' CK. M.O. CASH
3 9 9 N. Y 1.1 D 6 1,0 0
a � 3 � 90 - 7 � _ �. �