HomeMy Public PortalAbout4840 TEMPLE CITY BLVD_Mechanical__ 7eA364E LGE pIAA) Ain APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUILDING
(PRINT OR TYPE ONLY) ADDRESS 1/00 //
1 sqLASS
LOCALITY
NO TYPE OF APPLIANCE OR EOUIPMENT FEENEAREST
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INSPECTION RECORD
Plan check fee 25% of above
PERMIT ISSUING FEE
TOTAL FEE
PLAN CHECK APPLICANT
NAME ;qo,�ejQ/'f�•�CvV
ADDRESS `
CITY Oh`O le TEL NO /v / q
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 VENTILATING AIR
CONDITIONING
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF APPROVALS DATE INSPECTOR SSIGNATURE
CHAPTER 9 DIVISION 3 OF THE BUSINESS AND PROFESSIONAL CODE
OF THE STATE OF CALIF RNIA ROUGH -z 7 -
SIGNATURE FINAL
OF PERMITTE
PLAN CHECK VALIDATION CK No CASH PERMIT VALIDATION cN No CASH
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POLICY NUMBER: