HomeMy Public PortalAbout5717-5719 TEMPLE CITY BLVD_Plumbing__ 76AO67 ICE-6171- Dns
APPLICATION FOR PLUMBING_ PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING /
MAKE CHECKS PAYABLE TO ADDRESS
HARVEY T BRANDT, COUNTY ENGINEER LOCALITY •
FOR APPLICANT TO FILL IN (PRINT OR TYPE( NEARES
NUMBER FIXTURE OR ITEMCRO
O FEE
WATER CLOSET 1 75 'i .. OWNER_
MAIL
BATH TUB 1 75 ADDRESS
SHOWER 1 75 CITY ;TELNO42LAVATORY 175 CONTRACTSINK 1 75 ADOREDISHWASHER 1 75 ZCLOTHES WASHER 1 75 r1TATE IC 0pSE O 0 LASSL/
SWIMMING POOL RECEPTOR 1 75 LICEN
LAWN SPRINKLER SYSTEM 1 75
DISTRICT NO� GROUP Z NE FROC EjSED BY
lT
WATER HE 1 75 14A5ETAPPROVAL
GAS SYSTEM,,4r OUTLETS 1 75 " INSPECTION RECORD c�
OUTLETS OVER 9U , u Ir , I• �'
5 PER SYSTEM p
H
V
W
d
, H
Z
h
Plan check fee See Rexene
PLUMBING PERMIT ISSUING FEE $ B 00
TOTAL FEE
APPROVALS DATE INSPECTOR + eIGNATUNE '
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel NO GAS VENT
1
13 BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND
!TATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMB[NO - GAS TEST
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED RE51DENTIAL P PERTY FINAL
SIGNATURE r
OF PERMITT
PERMIT VALIDATION cK M o CASH
PLAN CHECK VALIDATION CK M O CASH
6 0 3iJAB r_6 5 0� 4.7 5 A%