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APPLICATION FO MIT
HEATING - VENTILATING - Al CONDITIONING
COUNTY OF LOS ANGELES ADDRESS
DEPARTMENT OF COUNTY ENGINEER - _0 AZ Z14664 ,4n6.,
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER `
(PRINT OR TYPE ONLY)
MAIL
No TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
CITY TEL. N
ABSORPTION UNIT, BTU 7226
CONTRACTOR
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU 4 Y, CI TEL. NO
COMPRESSOR, BTU STATE LIC
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT No. GRouP ZONE PR SSE- BY
EVAPORATIVE C ER 'g-
FURNACE.
�a / ( -FURNACE. FAU GR Y INSPECTION RECORD
FLOOR BTU
HEATER: SUSPENDE_ D UNIT_
WALL
a
O
U
OC
O
W
Cn
Plan check fee 25% of above. See reverse. z
PERMIT ISSUING FEE S,- 3 00
TOTAL FEE
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- sAPPROVALS _ DATE INSPECTOR'S SIGNATURE'
LATING, AIR CONDITIONIN
' ROUGH '
I HEREBY CERTI Y HAT I A NO ACTING IN VIOLATIO
OF CHAPTER 9, DIVIS N 3, OF 7H B ESS AN PR
CHAOFESSION FINAL,
CODE OF THE ST OF CALIFOR
SIGNATUR PERMIT VALIDATION CK. M 0. CASH ,
OF PERMI
PLAN CHECKVALIDATION CK M O CASH
6 c3 i1Aly i q u 1 5.5 0
SEE BACK OF APPLICATION FOR COM PLETE FEE SCHFOIILF e+y+.�