HomeMy Public PortalAbout4851 TEMPLE CITY BLVD_Plumbing__ 71A56710E 8171-4/72 �/ Gi >7/ , V
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
AIA KE CHECKS PAYABLE TO ADDRESS
HARVEY T BRANDT, COUNTY ENGINEER
LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TY PEI NEARE ST
CROSS ST SPAAP,�L STT
NEAREST
NUMBER FIXTURE OR ITEM ® FEE
OWNER `G O r
WATER CLOSET 1 75
MAIL p.
BATH TUB 1 75 ADDRESS J
SHOWER 1 75 CITY (� L NO.2fr— C
LAVATORY 1 75 CONTRACTOR - G
SINK 1 75 ADDRESS L. O
DISHWASHER 1 75 CITY �_ L NO a— O
CLOTHES WASHER 1 75 PIND
LIC
NO �� CLASS
SWIMMING POOL RECEPTOR 1 75
RICT NO GROUP ZONE PROCESSED BY
LAWN SPRINKLER SYSTEM 1 75 0 _
II <
WATER HEATER 1 75 PLOVAL
GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD
OUTLETS OVER5 PER SYSTEM30
S / . Mr
a
N
Z
Plan Check fee SS. Reverse
PLUMBING PERMIT ISSUING FEE S 3 00
TOTAL FEE let
APPROVALS DATE Ira PECTOR R SIGNATURE
Plan Check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel NO GAS VENT �n
HOT WATER HEATER
1 HEREBY ACKNOWLEDOE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 13 CORRECT AND AOREE TO COMPLY PLUMBING FIXTURES /� 1
WITH ALL COUNTY ORDINANCES AMD STATE LAWS REGULATING
PLUM BI NO GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF y�
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO IF _/(
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROP TY —�.-
FI NAL
SI ONATU RE
IN OF PERMITTEE
PERMIT VALIDATION w o CASH
PLAN CHECK VALIDATION CK M 0 CASH cK
WI(,p 9 3 4 54 W120 0 5 D 4.7 Jr r 7