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HomeMy Public PortalAbout4852 TEMPLE CITY BLVD_Plumbing__ 75AB67 (CE-817)-4/72 APPLICATION FDR' PL MBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO BUILDING ` ADDRESS HARVEY T. BRANDT, COUNTY ENGINEER LOCALI A: FOR APPLICANT TO BILL IN (PRINT OR TYPE) CROSS ST O i -00f 11 NUMBER FIXTURE OR ITEM ® FEE WATER CLOSET 1 75 OWNEfl MAIL BATH TUB 1 75 ADDRESS SHOWER 1 75 CITY TEL NO LAVATORY 1 75 CONTRACT SINK 1 75 ADDRESS DISHWASHER 1 75 CI /9 CLOTHES WASHER 1 75 LICENSE QEF( G LIC (,r 3,H6SWIMMING POOL RECEPTOR 1 75 DISTRICT NO I GRORR´┐ŻIP Z NE OCE ED V LAWN SPRINKLER SYSTEM 1 75 g RIq WATER HEATER 1 75 / WASDUTETAPPgOVAL GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD - OUTLETS OVER 30 I - 5 PER SYSTEM Q W 101- Plan Plan Check fee Snn RIII PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE APPROVALS DATE INSPECTOR + SIGNATURE Plan Check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel No GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THCABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUM SING GAS TEST I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RE9107T1 BOP[R TY FINAL SIONATU RE OF ISFIRMITTSkOW PERMIT IDATIONGK 0 CASH PLAN CHECK VALIDATION CK M 0 CASH I ACo 1 3 1 073 4 5 D 6.5 0- v