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HomeMy WebLinkAbout1389A76A364C CE - 8.18 1REV. 6,78) ©s APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING AND SAFETY R APPLICANT TO FILL IN (PRINT OR TYPE ONLY) PLAN CHECK VALIDATION J �I j ADDRESS ADDRESS !— / ' NAME LOCAL] ADDRESS - CITY TEL. NO. F APPLIANCE OR EQUIPMENT FEE NEAREST CROSS ST. ' ORDINANCES AND LAW REGULATIN ATING, VENTILATING, AIR PTION UNIT, BTU OWNER - ��,, lA 4&1C4.� / I HEREBY CE IFY TH T I AM NO ACTING IN VIOLATION OF —'.t � DLING UNIT, CFM OF THE STATE OFC LIFOR A. MAIL ADDRESS SIGNATURE , BTU FFURNACE: ��tl 2 ,GQ DISTRICT NO. w CIT ? TEL. NO. ESSOR, BTU CONTRALTO r �✓� �Q TION SYSTEM - ADDRESS ATIVE COOLER /f CITY �(✓J — TEL. NCI I E: FAU — — GRAVITY BTU STATE LIC. LICENSE NO. CLAS: SUSPENDED UNIT WALL— APPROVALS DATE INSPECTOR'S SIGNATURE ROUGH_,; .• o • --"'" FINAL °� ^ 0 45 7 INSPECTIO RECORD E2° 0 Plan check fee 25% of above. tA PERMIT ISSUING FEE $ �-- TOTAL FEE �,7� t'o PLAN CHECK APPLICANT PLAN CHECK VALIDATION NAME ADDRESS - CITY TEL. NO. IHEREBY ACKNOWLEDGE THAT I HAVE READ THISAPPLICATIONAND STATE THAT THE ABOVE IS CORRECT. AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAW REGULATIN ATING, VENTILATING, AIR CONDITIONING. PERMIT VALIDATION qq L7 �- I HEREBY CE IFY TH T I AM NO ACTING IN VIOLATION OF —'.t � CHAPTER 9, DIVISI N THE USIN SAND PROFESSIONAL CODE OF THE STATE OFC LIFOR A. :,`m -Q 6'0 4 1 SIGNATURE OFPERMITTEE ��tl 2 ,GQ DISTRICT NO. w PROCESSED ! 0 27, G6,G1— 7 9 .. � � :... Lr, �� ��