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TB A 35- CE [Ie-IiTe APPLfCAT10N FOR PXRMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING J
DEPARTMENT OF COUNTY ENGINEER ADDRESS o
BUILDING AND SAFETY DIVISION LOCALITY G/
NEAREST ^�
CROSS ST. Oak H
OR APPLICANT TO FILL 1 OWNER '1
(PRINT OR TYPE ONLY)
MAIL / r- aId /,
No. TYP:EBSIZEOFEQUIPMENT FEE- ADDRESS
e[[ SACK OF APPLICATION
CITY 1' EL. NO.,. �-
FORCE AIR FURNACE, BTU O
CONTRACTORA`4 4,Co 4
COMPRESSOR, BTUcry
ADDRESS Q�
VENTILATIQN''FAN7t. CIT �Lo�,p� C� TEL. NO. f-/
LIST ALLQTHERS BELC%V STATE LIC. _� J
LICENSE NO. O CLASS o
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DISTRICT NO.
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LNSPECTION RECORD
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Plan check fee. See reverse.
PER111T Iti.SUING FEF; 3
TOTAL FEE t O
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VEMTI- APPROVALS DATE -INS PECTOA7 SIG MA TUR[
LATING, AIR CONDITIONING.
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IM VIOLATION
OF CHAPTER 9, DIVISION OF THE BUSINESS AND PROFESSIONAL FINAL
LOF
OF THE STATE OF A FORM
ATURE PERMIT VALIDATIO CK. M.O. CASH
ERMITTEE
PLAN CHECK VALIDATION CK, M,O. CA4H
5 3 6F-'M 31 44. 1 9.5 0