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AA-"4- CE 61 8- 5-73 O'A FO PERMIT
BEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELESBUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
NEAR EST
CROSS ST
FOR APPLICANT TO FILL IN OWNER
• (PRINT OR TYPE ONLY)
MAI L
11
NO TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
CITY, j TEL NO. I —
ABSORPTION UNIT, BTUm n 0—di I-
CONTRACTO
AIR HANDLING UNIT, CFM
ADDRESS ^1
BOILER, BTU CITY cI� I0"+tjTEL NO ��70
COMPRESSOR, BTU `1a Wl STATE ^II LIC
LICENSE NO. p( ! CLASS
VENTILATION SYSTEM DISTRICT NO GROUP ZONES SED Y
EVAPORATIVE COOLER Q� ��B
FURNACE •F,AU GR ITY �J INSPECTION-RECORD
FLOOR BTU
HEATER. SUSPENDED—UNIT--
WALL
USPENDED UNIT=WALL
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Plan check fee 25% of above See reverse.
PERMIT ISSUING FEE S s 00
TOTAL FEE 3
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO
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, VENTI- APPROVALS DA E ECT R'S SIGNATURE
LATING, AIR CONDITIONING
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL +.
CODE OF THE STATE OF CALIFORNIA
SIGNATURE 1 • PERMIT VALIDATION cK M o CASH
OF PERMITTEE 0
PLAN CHECK VALIDATION CK M o CASH
4 0 41_"}fiaY`R'28 4 1 .9 1 3.0 C) ®j'
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE