HomeMy Public PortalAbout6316 TEMPLE CITY BLVD_Plumbing__ "A"I (C• 0170) •A/YT
APPLICATION FOR PLUMBING PERMIT
BUILDING SAFETY DIVIS Lf)LEan
FOR APPLICANT TO FILL IN(PRINT OR TYPEI BUILDING
ING 633.6
�+� Tbwle Ci
NUMBER FIXTURE OR ITEM O EE V /�
ty Blvd.
WATERCLOSET LOCALITY Er
BATH IUB NEAREST
vd
CROSSST
SHOWER OWNER Fairhaven Development
LAVATORY MAIL -
ADDAE558656
SINK CITY San Gabriel TEL NO
DISHWASHER CONTRACTOR Owen Broa. Plumq
CLOTHES WASHER ADOR65 4265 N• C�t7jn ASWIMMING POOL RECEPTORCITY ffi H(J]'jte TEL NOLAWN SPRINKLER SYSTEM /�,WATER HEATER LICESTATNSE NO 233' 741 LIC A
GAS SYSTEM OUTLETS DISTTCL.NO Up _jI ZONE P ESSED
O5 PER UTLETS 9w SYSTEM INDUSTRIAL
WASTE APPROVAL CC
INSPECTION RECORD 00
30 7 !oP Dv f %
Plan check fee
PLUMBING PERMIT ISSUING FEE 1
TOTALFEE
Plan check opphconT
APPROVALS DATE 5SIGNATu
Nome
UNDER SLAB WORK
Address ROUGH PLUMBING /
CITY Tel No GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAW READ THIS APPLH;ATJON AND STATE GAS VENT
THAT INE ABOVE 15 CORRECT AND ACME TO COMPLY WTN ALL COVNTY ORDINANCES
AND STATE LAWS REGUUTING PLUMBING HOT WATER HEATER
1 HEREBY CERTNY 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
rROPERTr UTILITYCO NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
PLAN CV�16rq Y:T.L CS �-.C;l,cc� r VSQr•AH PERMIT VALIDATION a is mo u H
POLICY HOLDER: 1,7r—Y" EV�� 14 OQ 4 0.0 0
OS9 7,,.J 22 5 0
POLICY NUMBER: n �' is" 33- �w r_