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�PLICATFOR PERM
HEATING - VENTILATING - AIR CO oil IONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO TYPE&SIZE OF EQUIPMENT FEE ADDRESS
SEE BACK OF APPLICATION
CITY TEL NO
FORCE AIR FURNACE BTU
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VENTILATION FAN CITY TEL 4�i
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PI 13N11 1551 I\( I I 1 e 3 00 `
1011 III
PLAN CHECK APPLICANT
NAME
ADDRESS --
CITY T E Li/$t 47
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING VENTI APPROVALS DATE INSPECTOR S SIGNATURE
LATING AIR CONDITIONING
ROJGH
I HEREBY CERTIFY THA AM NOT AC G IN VIOLATION
OF CHAPTER 9 DIVISION 3 THE BUA:��AL FINAL
CODE OF THE STATE F CA OR NIA
SIGNATURE PERMIT VALIDATION CK M o cnsH
OF PERMITTEE
PLAN CHECK VALIDATION M o CASH `
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