HomeMy Public PortalAbout5808 TEMPLE CITY BLVD_Plumbing__ 76A667A ME 6178)-11/76
APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO,FILLIN(PRINT ORTYPE). BUILDINS 5408 Temple City Blvd
NUMBER FIXTURE OR ITEM ® FEE ADDRES
WATER CLOSET LOCALITY Temple -City
NEAREST 01 i'v e
BATH TUB CROSS ST.
SHOWER OWNER Brenner, James
LAVATORY AMAIL
DDRESS 4 20 Temple City Blvd
:SINK CITYTemple City TEL.NO.285-2228
DISHWASHER CONTRACTOR
W E. Graham
CLOTHES WASHER ADDRESS 9127 Las Tunas Dr
SWIMMING POOL RECEPTOR
CITYTemple City TEL.NO: .286-9293
LAWN SPRINKLER SYSTEM
STATE LIC:
WATER HEATERre. lace 3 00 ICENSENO. 104466CLASS C-36
GAS SYSTEM OUTLETS DIST CT fVO� UP ZONE PROCESSED BY�
0ESS5PER YEM INDUSTRIAL
WASTE:APPROVAL
INSPECTION RECORD
us
Plan check fee
PLUMBING PERMIT ISSUING FEE$ 4.50
TOTAL FEE 1 7• O
Plan check applicant
APPROVALS DATE INSPECTOR'S SIGNATURE
-Name
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel.No. GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE GAS VENT. '
THATTHE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES r
AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER /0-40-7
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING'FIXTURES
REQUIRED BY LOS ANGELES COUNTY AND.STATE OF CALIFORNIA OR THAT I AM THE GAS TEST.
LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
56 Oft'--SEP 2 n 7.5OAbs
es