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APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES FADIED)RESS
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION Y i a"
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FOR APPLICANT TO FILL IN
(PRINT OR TYPE ONLY)
NO TYPE OFAPPLIANCEOR EQUIPMENT FEE TEL N
ABSORPTION UNIT BTU
CONTRACTO
AIR HANDLING UNIT CFM
ADDRESS
BOILER BTU CITY TEL NO Q
COMPRESSOR BTU STATE (} LIC
LICENSE NO d CLASS
VENTILATION SYSTEM DISTRICT NO GROUP ZONEocESSED BY
EVAPORATIVE COOLER rUO V(- 3
FURNACE FAUGRAVITY INSPECTION RECORD
FLOOR BTU
HEATER SUSPENUNIT_
WALL DS y
a
O
U
O
H
U
W
N
Pl-in check, fee 2S% of above See reverse 6 z
PERMI I ISSUI\'C FEES
TOTAL FEL
PLAN CHECK APPLICANT -O-=O 0 a"
NAME
ADDRESS
CITY TEL NO
LTHATBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
E THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
ORDINANCES AND LAWS REGULATING HEATING VENTI APPROVALS DATE INSPECTOR S SIGNATURE
IR CONDITIONING
ROUGH
EBY CERTIFY THAT I AM NOT AC G IN VIOLATION 'ER 9 DIVISION 3 O HE B (NESS D PROFESSIONAL FINALTHE STATE OF CAL NIARE PERMIT VALIDATION cK M o CASH
MITTEE
PLAN CHECK VALIDATION CK M 0 CASH
.� 8 l �ApR 1641 1) 120U � �
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE O