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CITY OF TEMPLE CITY
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES P 283
DEPARTMENT OF COUNTY ENGINEER
BUILDIJOHN ANG AND LAMBIESAFETY CouNTv DIVISION
ADORERS 5005 Tem le Cit Blvd.
COLEMAN W JENKINS SUPT OF BUILDING jOCALITY Temple City
FOR APPLICANT TO FHS IN CNEAREST
La Rosa & Lower Azusa
NUMBERFIXTURE OR ITEM EACH Pee Iiv►N® Halsey
WATER CLOSET 3125 NAD,
BATH TUB 145 ADDRESS
SHOWER 115 CITY TEL NO
LAVATORY in CONTRACTOR General Installation Co.
SINK 125 ADDRESS 8558 West Blvd.
DISHWASHER 125 Circ Los Angeles TEL NO FL 3-2541
LAUNDRY 7lTB 145 SATELICENSE NO C-38 151839_ CLASS
CLOTHES WASHER 115 DISTRICT NO GROUP ZONE PROCESSED BY
1 WATER HEATER 1 so 1 , 50 Q
GAS SYSTEM OUTLETS 150
WADTE�APPROVAL C
OUTLETS OVER 5 PER SYSTEM 50
INSPECTION RECORD E.D
WATER SOFTENER 'Ready for Inspeot No 0
APPROVALS DATE INSPECTOR 8 SIGNATURE
PERMIT S y GO UNDER SLAB WORK
TOTAL FEE
3 50 ROUGH PLUMBING
6A5 PIPING
I N[R[BY ACKNOWLEDGE THAT 1 XAV[ READ
IMI[ ARLICATION GAS VENT
•NO [TAT[ THAT THE ABOVE I[ CORI6CT AND AOR[I TO COMPLY
WITX ALL COUNTY ORDINANCE[ AND [TATE LAWS REGULATING HOT WATER HEATER
PLUMBING
I Nu[[Y CERT I FY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND RAT[ OP GAS TEST
CALIFORMIA OR THAT 1 AN THE LEGAL OWNER OF AND INTEND TO
BESIDE IN TM[ABOVE DESCRIBED R[[ID IAL/ UTILITY CO NOTIFIED
SIGNATURE (fes/-//
OF PERMITTEE
FINAL G
VALIDATION JACK R. ALLEN
cM M O CASH SUPERVISING MECWINICAL ENG'R
II�Cn8 1 5 3 0 M127 5 D 350-
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