HomeMy Public PortalAbout5021 AGNES AVE_Mechanical__ 76 A364,,.f CE 818 I/75
APPLICATIO FOR PERMIT
10, HEATING - VENTILATING - AIR CON011IONING
TEMPLE CITY
COUNTY OF LOS ANGELES BUILDING
S 5021 NO AGNES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST
FOR APPLICANT TO FILL IN OWNER FOLTZ ARTHUR -
(PRINT OR TYPE ONLY)
MAIL ABOVE
NO TYPE&SIZE OF EQUIPMENT FEE ADDRESS
SEE BACK OF APPLICATION
1 CITY TEMPLE CITYrEL No 285-8573
FORCE AIR FURNACE BTU 80.000 7 50
CONTRACTOR TRANE HCC
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ADDRESS 2034 NORTH PECK ROAD
VENTILATION FLAN CITY SO EL MONTErEL NO 579-7982
LIST ALL OTHERS BELOW ATE LIC
LICENSE NO 265094 CLASS C-20
DISTRICT NO GROUP ZONE P ESSED BY
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INSPECTION RECORD
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Plan check fee See reverse z
PI 011 1 11`,i Iv( I I I s 4 050
ro I \I 11_i 12 00
PLAN CHECK APPLICANT
NAME
ADDRESS
es
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 DATE INSPECTOR SSG RE
LATING AIR CONDITIONING
ROUGH _
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
AON
OF CHAPTER 9 DIVISION 3 OF THE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STATE OF CALIFOR A ( 1
SIGNATURE Y ` PERMIT VALIDATION CK M 0 CASH
OF PERMITTEE �l
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PLAN CHECK VALIDATION CK M 0 CASH
663AN 341 0 1200 ®�-o