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APPLICATION FOR PERMIT
" HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY. DIVISION LOCALITY / !!
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER / a
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE&SIZE OF EQUIPMENT FEE ADDRESS
SEE BACK OF APPLICATION
CITY TEL. NO. T
FORCE AIR FURNACE, BTU '
CONTRACT R �� /�� �
COMPRESSOR, BTU
ADDRESS
VENTILATION FAN � s
CITY =G�L � TEL. NO. -
LIST ALL OTHERS BELOW STATE LIC.
LICENSE NO. CLASS
OM
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DISTRICT N0. GROUP ZONE
E PROCESCES
SED BY
INSPECTION RECORD
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Plan check fee. See reverse. z
PRR\II"f ISSI`IVG FF,V S
PLAN CHECK APPLICANT
NAME
ADDRESS
CI TY 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 INSPECT�'S• IGNATURE
LATING, AIR CONDITIONING.
ROUGH �3r^-
IHEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STATE OF CALIFORNIA.
SIGNATURE PERMIT VALIDATIO CK. M.JI. CASH
OF PERMITTEE
PLAN CHECK VALIDATION CK. m.0. CASH
7r-OCT 5 4 1 a 1 2.0 0 �y