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APPLICA N FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES :BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS vC _
BUILDING AND SAFETY DIVISION LOCALITY LC 1
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER12
(PRINT OR TYPE ONLY)
MAIL
N0. TYPE&SIZE OF EQUIPMENT FEE ADDRESS
SEE BACK OF APPLICATION
f'q CITY TEL. NO.-7
FORCE AIR FURNACE, BTU _ O
CONTRACTOR Lam,
COMPRESSOR, BTU -/-` 'n � ,
ADDRESS
VENTILATION FAN CITY 7 TEL. NO.
411-1L
LIST ALL OTHERS BELOW STATE LIC.
LICENSE NO. 2 CLASS e Z�
DISTRICT NO. GROUP TONE PR ESSED/BY
INSPECTION RECORD
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Plan check fee. See reverse. ?
F'I;It)11'f ISSI'I\'(: PF;F: S .6-OD
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY --
WITH ALLORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING.
I HEREBY CERTIFY AT I AM NOT ACTING IN VIOLATION ROUGH
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OF CHAPTER 9, DIVISIO OF THE BUSINESSANDPROFESSIONAL FINAL
CODE OF THE STATE 0 LIFOR NIAI
SIGNATURE PERMIT VALIDATION cK. ' M.0. CASH
OF PERMITTEE
PLAN CHECK VALIDATION CK. M.0. CASH
1 2 9 JAtJ 1:5 4 1 U 1 2.0 U A".z .
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