HomeMy Public PortalAbout5728 AGNES AVE_Mechanical_7/3/1978_ 76A364-CE818-1/70 APPLICATION FOR PERMIT
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HEATING - VENTILATING - AIR CONDITIONING
COUNTY,OF LOS ANGELES BUILDING �T' z 0 — GN ES
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY C
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUPERINTENDENT OF BUILDING NEAREST
CROSS ST WL1 I
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) 1n `
No TYPEOFIAPPLIANCEOR EQUIPMENT FEE ADDRESS F7 T C
CITY TEL NO /47 6- ;Z 72
ABSORPTION SYSTEM BTU
CONTRACTOR"" � ^
AIR HANDLING UNIT CFM
v ADDRESS
BOILER HORSEPOWER CITY TEL NO
COMPRESSOR HORSEPOWER STATE LIC
LICENSE NO CLASS
VENTILATION SYSTEM DISTRICT NO CLASS GROUP ZONE C���PROCESSED BY
EVAPORATIVE COOLERpq
FURNACE� FAU_GRAVITY IN CTI N RECO
FLOOR BTU
HEATER SUSPENDEDUNIT_
WALL (J r
r
{ a
c
Q c.
C
F
S 4
° v
EW ADDITION— PERMIT $ 3 00 ?
` r
ALTER_REPAIR', TOTAL FEE $ r
PLAN CHECK APPLICANT V
NAME
ADDRESS hi
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 SPE ORS SIGNATURE
LATING AIR CONDITIONING
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9 DIVISION 3 O�THE US[NESS AND PROFESSIONAL FINAL
CODE OF THE STATE OF L F
SIGNATURE JACK R ALLEN SUPERVIS CHANICAL ENG R--
OF PERMITTEE
PERMIT VALIDATION cK M O - CASH '`` �-
PLAN CHEC VALIDAT N
l Ar-, 8 d 0 9� �/f FEB „0 4 1 D J C�
1 � M
f f A
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE '