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P ATIOPI FOR PERMIT
HEATIPlG - EIdTILATIHG - AIR CONDITION
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS J >`•L
BUILDING AND SAFETY DIVISION LOCALITY
NEARES �•
CROSS ST"
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) -
MAI L
NO. TYPEOFAPPLIANCEOR EQUIPMENT FEE ADDRES ,
CITY TEL. NO
ABSORPTION UNIT, BTU
CONTRACTOR
AIR HANDLING-UNIT,. CFM °
ADDRE -
BOILER, BTU
CIT .TEL. NO.
COMPRESSOR, BTU STATE LIC.
LICENSE NO. , CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER �� O
FURNACE-: FAU GRATY INSPECTION RECORD
FLOOR BTU
HEATER: SUSPENDED UNIT_
WALL y
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O
U
O
V
W
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Plan check fee 25% of above. See reverse.
PERMIT ISSUING FEE S 3 00
TOTAL FEE '
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT KNAVE READ THIS APPLICATION -
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE - INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING. -
ROUGH .. "
IHEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF THE BUSINEaz0
ESSIONAL FINAL
• CODE OF THE STATE C FORNI
SIGNATURE PERmgr.VALp)D TIpN _CK. M:O.J CASH)OF PERMITTEE
CAI O Q, G o.
PLAN CHECK VALIDATION CK. M.O. CASHQ O N N G Q
�1 al o ¢t
-4 (D C)
00 O C)
CH
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE