HomeMy Public PortalAbout6225 TEMPLE CITY BLVD_Plumbing__ 76�A 667-,CE 817 4-68 ` I
APPLICATION FOR P.LUMBI G PERMI
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER �p
BUILDING AND SAFETY DIVISION ADDRENG
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JOHN A. LAMBIE. COUNTY ENGINEER
ST
COLEMAN W. JENKINS. SUPT:OF BUILDING LOCALITY -MA4'P� G�
NEAREST
FOR APPLICANT TO FILL IN(PRINT OR TYPE) NEARE
CROSS T. �C`�/� s t�t)10
NUMBER FIXTURE OR ITEM EACH FEE.
OWNER
WATER CLOSET 1.50 11<, *
MAIL
BATH TUB 1.50 ADDRESS
SHOWER 1.50 CITY TEL. NO.
LAVATORY 1.50 Cj CONTRACTOR 0
SINK 1.50 , a ADDRESS
DISHWASHER 1.50 !" CITY ( � � TEL.NO. y
PATE LIC
CLOTHES WASHER 1.50 LICENSE NO. J�. Cj CLASS
SWIMMING POOL RECEPTOR 1.50 DISTRICT Nq.y G ZONE E BY
LAWN SPRINKLER SYSTEM 2.00 j/
WATER HEATER 1.50 ( INDUSTRIAL @x!!11
WASTE.APPROVAL
GAS SYSTEM OUTLETS 1.50 INQECTION RECORD. 0
OUTLETS OVER 30
5 PER SYSTEM zg
Oe
N
Plan check fee 25%.of above. See reverse.
PLUMBING PERMIT ISSUING FEE 8 2 00
TOTAL FEE D APPROVALS DATE APECTOR'S/5191NATURF
Plan check applicant UNDER SLAB WORK
Name ' ROUGH PLUMBING
Address GAS PIPING TV 1
GAS VENT P
City. Tel. No.
_ HOT WATER HEATER _
1 HEREBY ACKNOWLECGE THAT I HAVE READ THIS APPLICATION -
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING. Vol;A
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED .AND/OR UTILITY CO.NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ^�
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL Ifly
—'
SIGNATURE ��� JACK R. ALLEN, SUPERVISINGCHANICAL EN'G'R.
OF PERMITTEE
PERMIT VALIDATION C K. M.O. CASH..
PLAN CHECK VALIDATION CK. M.O. CASH
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