HomeMy Public PortalAbout6313 AGNES AVE_Mechanical__ 76 A364 CE 818 5-73
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES ADDRESS �3/
c
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) ,Y /
MAI L
NO TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
CITY TEL NO
ABSORPTION UNIT BTU
CONTRACT
AIR HANDLING UNIT CFM
ADDRES .,2 /
BOILER BTU CIT
COMPRESSOR BTU ST TE O`` CLIC
LASS v
LICENSE (
VENTILATION SYSTEM DISTRICT NO GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER
FURNACE FAUGRAVITY FLOORTU INSPECTION RECORD
HEATER SUSPENDED-UNIT-
WALL
USPENDED UNIT_WALL
a.
O
U
O
U
W
C�
Plan check fee 25% of above See reNerse
PERMIT ISSUING FEF 9 3 00
TOTAL FEE O
PLAN CHECK APPLICANT
NAME
r
ADDRESS
CITY TEL NO
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WLTH ALL ORDINANCES AND LAWS REGULATING HEATING VENTI APPROVALS DATE INSPECTOR S SIGNA1URE
LATING AIR CONDITIONING
ROUGH I
IHEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9 DIVISION 3 OF THE BUSINESS ANDPROF SSIONAL FINAL �
CODE OF THE STATE OF CALIFORNIA � ! f
SIGNATURE PERMIT VALIDATION cK M 0 CASH
OF PERMITT
PLAN CHECK VALIDATION CK M 0 CASH
7 2 29" 49 41 D 8.0-0 0
ry
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE