HomeMy Public PortalAbout5120 TEMPLE CITY BLVD_Plumbing__ 756557 (CE 8171-4/72 � ,
APPLICATION ORP MBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ID BUILDING
MAKE CHECKS PAYABLE TO ADDRESS
HARVEY T BRANDT, COUNTY ENGINEER LOCALITY
=FOR TO FILL IN (PRINT OR TYPE( NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM ® FEE _
OWNER
WATER CLOSET 1 75 _ _
BATH TUB 1 75 ADDRESS �^
SHOWER 1 7$ S CITY TEL NO
LAVATORY 1 75 CONTRACTOR
SINK 1 7S ADDRESS
DISHWASHER 1 75 CITY TEL NO�
CLOTHES WASHER 1 75 STATELIC /'
SWIMMING POOL RECEPTOR 1 75
LICENSE NO �3 S 6 CLASS P- 3(p
DISTRICT NO GROUP ZONE CESSED BY
LAWN SPRINKLER SYSTEM 1 75 LL US7p1 L —�
WATER HEATER 1 7S J yyASTE APAPfl OVAL o�
GAS SYSTEM 3 OUTLETS 1 75 INSPECTION RECORD O
OUTLETS OVER
5 PER SYSTEM 30 C
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Plan check fee See Reverse r1 ! /
PLUMBING PERMIT ISSUING FEE S 3 DO
TOTAL FEE
APPROVALS JDATE vECTOR a 1<NATa RE
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
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PL UMSIN0 GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY RE013TERED AMD/OR UTILITY CO NOTIFIED Wr/ 119
LIC ENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LE L OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED IDEMTIAL PARTY FINAL
SIGNATURE
OF PERMITTEE
PERMIT VALIDA 1 cK M o CASH
PLAN CHECK VALIDATION CK M 0 CASH �
I Ar, 2 2 2 0)3 gut 16 D 13 .5
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