HomeMy Public PortalAbout6233 ROSEMEAD BLVD_Plumbing__ 76A667C (CE-e17B) -975
APPLICATION FOR PLUMBING PERMIT
C I T�) oli- T F- 0)-ft C- C I T�l
BUILDING AND SAFETY DIVISION y--''��.((��
FOR APPLICANT TO FILL IN (PRINT OR TYPE) ADDRESNG S rR. /n09D 96toI
NUMBER FIXTURE OR ITEM @ FEE
WATER CLOSET LOCALITY —/ ?13Z GIZT-
NEAR
BATH TUB
CROSS ST.
SHOWER OWNER A t uO
LAVATORY MAIL 3
ADDRESS f U�y�
SINKt_Pi (t-c',"U CITY ��/�Cr� /'� TEL. NO. f( e fa 16/
DISHWASHER CONTRACTOR -TCS
CLOTHES WASHER
ADDRESS f dqQe) C--
SWIMMING POOL RECEPTOR
LAWN SPRINKLER SYSTEM CITY �Z=�7�L� j TEL. NO. 7 7 ^Ico
STATELIC
WATER HEATER LCENSE NO. !U CLASS r�
O.
GAS SYSTEM OUTLETS DIS-�T-RI G'C I GROUP IZONE I RO�S$ J V
OUTLETS OVER �C CD
5 PER SYSTEM INDUSTRIAL IG
WASTE APPROVAL LLI
a
INSPECTION RECORD Z
Plan check fee
PLUMBING PERMIT ISSUING FEE $ L ^�
TOTAL FEE
Plan check applicant
Name APPROVALS DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel. No. GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I 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.
I 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 DESCRIBED ESI DENT IAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATU RE
OF PERMITTEE� — FINAL
s
PLAN CHECK VALIDATION CK. M.O. CASH 'PERMIT VALIDATION CK. M.O. CASH