HomeMy Public PortalAbout5025 WILLMONTE AVE_Mechanical__ 78 A364-'LE 818-1/75
APPLICA N FOR PERM
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING �^ r
DEPARTMENT OF COUNTY ENGINEER ADDRESS lLIE
BUILDING AND SAFETY DIVISION LOCALITY ~ rr� - C�
NEAREST i
CROSS ST. :.,
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL LL
NO. TYPE&SIZE OF EQUIPMENT FEE ADDRESS p7U Q
SEE BACK OF APPLICATION -
FORCE AIR FURNACE, BTU CITY I !l - TEL. NO. -"j f /Q
v CONTRACTOR r
COMPRESSOR, BTU " -
ADDRESS o&�
VENTILATION FAN ; CITY TEL. NO.
LIST ALL OTHERS BELOW STATELIC. r
LICENSE NO. CLASS -
•
DISTRICT NO. GROUP ZONE CESSED BY
INSPECTION RECORD
f i 1/7 5,7/ .4r,�crir Go.�vTn /2 6; a
c�2,✓ZG=� ate, i�1r+�.�.._,� v
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Plan check fee. See reverse. z
F'(:H111'I' 1tiSl;I1'G F'I;F: 3 0� -
TOTAI. 1 Eh-
PLAN CHECK APPLICANT
NAME
ADDRESS
CI TY TEL.NO.
1 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 HEAT�G.OL:T1 T'= APPROVALS DATE INSPECTOR'S SIGNATURE
LATING.AIR CONDITIONING. ROUGHI HEREBY CERTI Y HAT I AM NOT ACTT GINIION
OF CHAPTER 91 DIVI I OF Tt#E BU NESS D P ESSIONAL FINAL
CODE OF THE STATE LIFORNIA.
SIGNATURE
OF PERMIPERMIT VALIDATION c M.o. cnsH
TTEE
PLAN CHECK VAL1DATl CK, M.O. CASH
17
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