HomeMy Public PortalAbout4847 TEMPLE CITY BLVD_Plumbing__ nAQVC IT-n vel -9/GB I - . �C� Jay C(ci y
APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN (PRINT OR TY PE) BUILDING
NUMBER FIXTURE OR ITEM ® FEE ADDRESS B Clr7 J,J/UQ
WATER CLOSET LOCALITYTem2l�- CC
NEAREST A
BATH TUB CROSS ST OW ar �.Cc fF
SHOWER OWNER r I4Ili
r
LAVATORY MAIL
ADDRESS L�
SINK CITY S TEL NO
DISHWASHER CONTRACTOR eca
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR
TEL NO
LAWN SPRINKLER SYSTEMSTATE CITY TEL
(�C
LC
WATER HEATER LICENSE NO `J b OT 6 CILASS �—
GAS SYSTEM OUTLETS DISTRICT NO GROUP ZONE P OC ED BY S
OUTLETS OVER `S 00
5 PER SYSTEM INDU?% G
q L CFD
r WASTE APPROVAL W
INSPECTION RECORD d
Z
r —
s
Plan check fee
PLUMBING PERMIT ISSUING FEE $ I
TOTAL FEE /Q Plan check applicant
Name APPROVALS DATEUNDER SLAB WORK
Address ROUGH PLUMBING
City Tel No GAS PIPING
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICGAS VENT
AND STATE THAT THE ABOVE IS CORRECT ANO AGREE TO COWITH ALL COUNTY ORDINANCES ANO STATE LAWS REGULHOT WATER HEATER
PLUM SING
IXlRCBTERTIFY T AM PROPERLY REGISTE RED ANPLUMBING FIXTURES
LICEM9E0 AS REGUIRLO09ANGELES COUNTY AND STAGAS TEST
CALIFORNIA OR TXAT E LEN ANO IN RESIDE IN THE ABOVE C BED R L PROPERTYUTILITY CO NOTIFIED
51GNATU M1
OF PER MITTE FINAL
PLAN CHECK VALIDATION CK M G CASH PERMIT VALIDATIOkWO CK M a CASH
862�PJUN ' 9 5D lO.00 •'d
SrA,r,t:F cohxNsarlo,✓ rzuKo. -
41 y 6/ 027-01