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76 A36¢J- CE 818- 5-73
APPLICATION FOR PERMIT
mow" HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY lC lg
NEAREST �
CROSS ST. 6.4/LI
FOR APPLICANT TO FILL IN OWNER ,I /�
(PRINT OR TYPE ONLY) v C`-�
MAIL / nn�� y�
NO. TYPEOFAPPLIANCEOR EQUIPMENT FEE ADDRESS �/J Iv �Kp�W /�,
ABSORPTION UNIT, BTUCITY e/h li, Cj� TEL. NO. }�}�(�„ 5301
'' CONTRACTOR EENtRl k o c"09. EgIr qr.0.
AIR HANDLING UNIT, CFM �J lL
ADDRESS 90,0 ER JVV E Sv/��/•7 p
BOILER, BTU CITY ,� f� oi>r/7� TEL. NO. Yy3/n�/0
�/?� STATE LIC.
COMPRESSOR, BTU o� � LICENSE NO. I�16 0 CLASS `-o"C2
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER
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FURNACE: FAUGRAVITY INSPECTION RECORD
FLOOR BTU
HEATER: SUSPENDED UNIT_
WALL
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20 / 75,0 o
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Plan check fee 25% of above. See reverse.
PERMIT ISSUING FEE S 3 00
TOTAL FEE J`
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO..
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENT]- APPROVALS GDAT E- I) INSP�,Tb R'S SIGNATURE
LATING, AIR CONDITIONING. /
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
CH
OF CHAPTER 9, DIVISION 3, OF THE BUST ESS AND PROFESSIONAL FINAL f
CODE OF THE STATE 0 A IFO NI
SIGNATURE � PERMIT VALIDATIONcK / M.O. CASH
OF PERMITTEE
PLAN CHECK VALIDATION CK. M.0. CASH
7 2 .4n FEB 15 4.1 U 15-5 ()
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE