HomeMy Public PortalAbout5472 TEMPLE CITY BLVD_Plumbing__ EIT 3 ._ TEMPLE COTY
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APPLICATION FOR PLUMBING PERMIT/
COUNTY OF LOS ANGELES
DEPAARTTME�NTp�OpF COUNTY ENGINEER F
BJUO%D LAM�IE COUNTY DM3�ON j�7�' �r
WILLIAM A JENSEN SUPT OF BUILDING a
G'
FOS APPLICANT TO FILL IN ET
NUMBER FIXTURE OR ITEM EACH FEE ST
WATER CLOSET 5125
BATH TDB 115 ADDRESS
SHOW1'9 115 CITY TEL NO
LAVATORY 115 CONTHACTOH h
SING 115 ADDRESS S— . f�
DISHWASHER 115 Cm TEL NO _
ATE
LAUNDRY TUB 1 25 REGISTRATION NO COUNTYY
CLOTHES WASHER 115 DISTRICT NO GROUP NE �ESSFD BY
WATER HEATER 1 SS �l/
GAS SYSTEM A OUTLETS- 13R INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSrEK 10 DtBPZCTION HEC _
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a
O
APPROVALS OWE IN.P[CTprtlrtT.IdNXTUR[
PERMIT S 2 oO UNDER SLAB WORT
ROUGH PLUMBING
TOTAL FEE GAS PIPING /�f?'�(�C.(�.I
I N[R[RY ACKNOWLEDGE THAr I HAV[ RUD THIS APPLICATION
AND
.TAT[ THAT TUX A.OV[ IS CORRECT AND ACME TO COMPLY GASVENT
WITH ALL COUNTY OROINANC[. AND .TAT[ LAW. R[OULATINO
NOT WATER HEATER
PLUMBING
1 H[RmT CERTIFY THAT I AM PRO'IRLY REGISTERED ANO/OR PLUMBING FIXTURE
LICXN.[O AS R[GUIR[D BY LOS ANO[LU COUNTY AND STAT[ OF GAS TEST f
CALIFORNIA OR THAT I AM TN[ LEGAL OWIRR OF AMO I D TO
Ro1D[ IN THE ASOV[ D[.CRI.[D R[SI NTUL PIIOP[RfY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTE FINAL
ATION ROBE A D
CK M O WH SUPER SING MECHANICAL ENG R
Lj,o4397G If 8 5 D 15.00-
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