HomeMy Public PortalAbout6324 ROSEMEAD BLVD_Plumbing__ 7�6A667 (CE-617)-4/72
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: BUILDING
ADDRESS
HARVEY T. BRANDT, COUNTY ENGINEER
LOCALITYeng 4"
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FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST4
CROSS ST.
NUMBER FIXTURE OR ITEM @ FEE ,
WATER CLOSET 1.75 OWNER
MAIL
BATH TUB 1.75 ADDRE$
SHOWER 1.75 CITY TEL. NO.
LAVATORY 1.75 Sr CONTRACTOR
SINK 1.75 ADDRESS /
DISHWASHER 1.75 CITYTEL. NO.
CLOTHES WASHER 1.75 STATE q LIC
LICENSE NO. v CLASS (�
SWIMMING POOL RECEPTOR 1.75
DISTRICT NO. GROUPZONE E S S E D BY
LAWN SPRINKLER SYSTEM 1.75
L�
WATER HEATER 1.75 INDUSTRIAL
WASTE APPROVAL ar
GAS SYSTEM OUTLETS 1.75 NSPECTION RECORD V
OUTLETS OVER '
5 PER SYSTEM .30 C
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ 3 00 /
TOTAL FEE Sv
APPROVALS DATE IN PECTOR'5 SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING )
Address GAS PIPING
City Tel. No. GAS VENT
-'AOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT.1 HAVE READ THIS APPLICATION:.
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY" PLUMBING FIXTURES
WITH ALLCOUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY G.O. NOTIFIED
LICENSED AS REQUIRED BY S ANGELES COUNTY AND STATE OF
CALI FORN IA OR THAT I' AM LEGAL NER OF, AND INTEND TO
RESIDE IN THE ABOVE DES 1 D RESIDENT AL PROPERTY. FINAL
4/2
SI GNATU RE
Ln;OF PERMITTE 4V
PERMIT VALIDATION CK. M.0. CASH
PLAN CHECK VALIDATION CK. MtO. CASH
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