HomeMy Public PortalAbout6052 TEMPLE CITY BLVD_Plumbing__ 7GA667 (CE-817( - 1/75 ('1171- 4
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APPLICATIO FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: 7NEAREST
of J
HARVEY T. BRANDT, COUNTY ENGINEER
FOR APPLICANT TO FILL IN (PRINT OR TYPE) .
NUMBER FIXTURE OR ITEM @ FEE ' p
WATER CLOSET
2.00 OWNER i. J a
MAIL
BATH TUB 2.00 ADDRESS
SHOWER 2.00 CITY TEL. NO.
LAVATORY 2.00 CONTRA 'IFIC INT LLERS
SINK 2.00 ADDRES I'
DISHWASHER 2.00 CITY
CLOTHES WASHER 2.00 STATE I
LICENSE NO. r CLASS
SWIMMING POOL RECEPTOR 2.00
DIS��ICT Nom.GROUP �Z PRO SED BY
LAWN SPRINKLER SYSTEM 2.00 L7�—
WATER HEATER 24ff INDUSTRIAL
WASTE APPROVAL a
GAS SYSTEM OUTLETS 2.00INSPECTION RECORD v
OUTLETS OVER 30
5 PER SYSTEM
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W
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. No. GAS VENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ :rH 15 APPLICATION HOT WATER HEATER
AND STATE THAT THEABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER F, AND !N'rENb TO
RESIDE IN THE ABOVE DESCRIO
P R DENTI OPER TY. FINAL �i� fC ��,
SIGNATU RE Ir
OF PERMITT
PERMIT VALIDATION M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
I Mew 22 15 Q
READY FOR MAL fe
09Y�'