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APPLICATION FOR PERMIT
HEATIN,G'- VENTILATING - AIR CONDITIONING
' COUNTY OF LOS ANGELES - ADDRESS
DEPARTMENT-OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST e �j
' CROSS ST .�a�C OCl�✓�
FOR APPLICANT TO FILL IN OwNER
(PRINT OR TYPE ONLY) MAIL A
NO TYPE&SIZE OF EQUIPMENT FEE ADDRESS
SEE BACK,OF APPLICATION'
CITY" TEL NO
FORCE AIR FURNACE, BTU
CONTRACTORLL L d -
COMPRESSOR, BTU- ADDRESS
VENTILATION FAN CITY -
o—F��TEL NO -3 LIST ALL OTHERS BELOW STATE 4
LIC
LICENSE NO. IC v C CLASS C
• o hO0 /!�/J // ,/I� ❑ISTRICT NOp� GROUP ZONE PROLE ED BY
7 V INSPECTION RECOR
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Plan check fee. See reverse-. z
PI111N1UII1551,11C f''I,1
TO� % D
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A ICATI ON
AND STATE THAT THE ABOVE IS CORRECT AND AG 0 OMPLY
WITH ALL ORDINANCES AND LAWS REGULATIN EATING, ENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING
ROUGH ,
IHEREBY CERTIFY TH I AM NOT ACTING IN V LATIO
OF CHAPTER 9, DIVISIO OF THE BUST ESS AND PROFESSION FIN
CODE OF THE STATE LIFORNIA
SIGNATURE RMIT VALID ION cK '� M o CASH
OF PERMITTEE_`, wo '-I'' ///��� ,
~v � ��ffNNI 1 1�N CASH /,
POLICY HOLDER:
POLICY NUMBER: 6t -7 / 5 -2 ,(0 �,.