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76 A364 - CE 818 - 9-71 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING / i/ l
DEPARTMENT OF COUNTY ENGINEER ADDRESS (QY
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST. f
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL : +
NO TYPEOFAPPLIANCEOR EQUIPMENT FEE ADDRESS J5
CITY ' C' EL. NO.
ABSORPTION UNIT, BTU
CONTRACTOR
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU -/�`
CITY f G �14 G r-' EL. NO. ...
COMPRESSOR, BTU STATE LS- LIC
LICENSE NO CLASS
VENTILATION SYSTEM DISTRICT NO GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER 0 a
FURNACE. FAUGRAVI7'Y t
/ FLOOR BTU �OP 1Y1 INSPECTION RECORD v
HEATER: SUSPENDED UNIT_ c:)
WALL U
W
CL
N
Z
Plan check fee 25% of above. See reverse.
PERMIT ISSUING FEE 8 3 00
TOTAL FEE 3
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- APPROVALS DAT INSP R'S SIGNATURE
LATING, AIR CONDITIONING
ROUGH
CHAPTER
CERTIFY THAT I AM NOT ACTING IN VIOLATION
C
OF HAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STATE OF CALIFORNIA
SIGNATURE �i w A a ' PERMIT VALIDATPON CK M o CASH
OF PERMITTEE_ l
PLAN CHECK VALIDATION CK, M 0 CASH
41-, 2 9 3 073 AUG, 4 4 1 D 1 3,0 0
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE