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APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES FBUILDINGDDRESS Q DEPARTMENT OF COUNTY ENGINEERBUILDING AND SAFETY DIVISION ALITYe[� CiT�[REST
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(PRINT OR TYPE ONLY)
LNO TYPE&SIZE OF EQUIPMENT FEE RESS 163 JV C17-124j,$ AVA-/yLjE
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALLOROINA N CES AND LAWS REGULATING HEATING VENTI APPROVALS DATE INSPECTORS SIGNATURE
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HEREBY CERTIFY THAT NOT ACTING IN VIOLATION
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HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES FBUILDI
EN DEPARTMENT OF COUNTY ENGINEERBUILDING AND SAFETY DIVISION ALITYREST
S STR APPLICANT TO FILL(PRINT OR TYPE ONLYI
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NO TYPE&SIZE EQUIPMENT EEE ADDRESS C
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FORCE AIR FURNACE BTU
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PLAN CHECK AP ICANT
NAME
ADDRESS
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I HEREBY ACKNOWLEDGE THAT THIS APPLICATION ,
AND STATE THAT THE Aa OVE IS CGREE TO COMPLY -
WITH ALL ORDINANCES AND LAWS HEATING VENT[ APPROVALS DATE INSPECTORS SIGNATURE
LATING AIR CONDITIONING
ROUGH '
I HEREBY CERTIFY THAT I ING IN VIOLATION
OF CHAPTER D DIVISION 3 Or THND PROFESSIONAL FINALCODE OF THE STATE Or A ORNISIGNATUREPERMIT VALIDATION CA Mo CASH `
OF PERMITTEE
PLAN CHECK VALIDATION cN M 0 CASH _ -
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