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APPLICATION FOR PERMIT
HEATING - VENTILATING : AIR CONDITIONING
I-'-",COUNTY OF LOS ANGELES BUILDING AND,SAFETY
FO R.APPLICANT TO FILL IN Cn�
ADDRESS.g 1`IZ OJ�f" to
(PRINT OR TYPE ONLY)
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NO. TYPE OF'AP PLIANCE OR EQUIPMENT FEE LOCALITY
NEAREST
. CROSS ST.
AB50RPTION UNIT,BTU
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OWNER SSS
AIR HANDLING UNIT.CFM MAIL
ADDRESS s � jt morr_A V
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BOILER,BTU CITY r hC r'!!Y- TEL.NO.'dddd Z
COMPRESSOR.BTU f CONTRACTOR _le Al J, I� Q✓�
VENTILATION SYSTEM /�-1l: IY /
ADDRESS %S�1O ��
EVAPORATIVE COOLER CITY e 9.?B o7 TEL.NoFLJRNA .
FLOOROE: FAU BTU GRAVITY STATE LIC.
LICENSE NO.C-q 0�.3aS�J 6 CLASS
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HEATER: SUSPENDED UNIT_ APPROVAL5 DATE INSPECTOR'SSIGNATURE
WALL
ROUGH r
Y
3T ✓ e/dam/ r' o
FINAL O
INSPECTION RECORD V
CC
O
11—
Non
Non check fee, 25% of above.
PERMIT ISSUING FEE$ 1 ,00 Z
TOTAL FEE O
PLAN CHECK APPLICANT PLAN CHECK VALIDATION
NAME
ADDRESS 9 10 4.6 A
CITY 3 �.,�.� TEL.NO. O O e a I}
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL G e ,'It
.O O
ORDINANCES AND LAWS REGULATING HEATING. VENTILATING, AIR n
CONDITIONING. PERMIT VALIDATION .o o e 1 7O05
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF /� Z p p
OFTHER'9,STADIVISION THE BUSINESSANDPROFESSIONAL CODE I Q3O- / 8
SIG NATd RE '•
'OEPERM ITTFF
DISTRICT NO. L 1PROCESSED 6
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