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APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR-CONDITIONING
COUNTY OF LOS ANGELES ADDRESS ✓ems
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY -57
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NEAREST
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FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
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NO TYPE&SIZE OF EQUIPMENT FEE ADDRESS
SEE BACK OF APPLICATION
CI Y TEL NO
FORCE AIR FURNACE BTU
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COMPRESSOR BTU
ADDRESS
VENTILATION FAN ° CITY TEL NO
LIST ALL O ERS BELOW STATE too LIC
LICENSE NO CLASS
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INSPECTION RECORD
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YI It\III ISSIII\( IFI �
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PLAN CHECK APPLICANT
NAME ^ s
ADDRESS �^
CI TY TEL NO '
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION '
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALLORDINANCES AND LAWS REGULATING HEATING VENTI APPROVALS DATE INSPECTOR S SIGNATURE
LATING AIR CONDITIONING
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER-9 DIVISION 3 OF THE BUSINESS AND PROFESSIONAL FINAL �" �7
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E OF THE STATE OF CALIFORNIA
NATURE PERMIT VALIDATION � M o CASH
PE RMI TTE
PLAN CHECK VALIDATION CK M 0 CASH
3591 JAN 2% 41 U 12VU �
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