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76 A364 - CE 8 18-1/75
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES [BUILDING
DEPARTMENT OF COUNTY ENGINEER DRESS
BUILDING AND SAFETY DIVISION CALITYrg
ARESTO ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) Y
MAI L
N0. TYPE&SIZE OF EQUIPMENT FEE ADDRESS l,(1J
SEE BACK OF APPLICATION �-
CITY TEL NO
FORCE AIR FURNACE, BTU
CONTRACTO
COMPRESSOR, BTU
ADDRESS
VENTILATION FAN CITY ',! TEL. NO. &- l /
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LIST ALL 9THERS BELOW STATE LICENSE NO. O CLASSG�3
DISTRICT NO. GROUP ZONE PROCESSED BY
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INSFAECTION FeECO RD
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Pian check fee. See reverse. z
PE:H�iI'I' 1,551;1\G I I:I: 3 00
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PLAN CrIJECK APPLICANT / J+
NAME
ADDRESS fl'fjl
CITY 1- TEL.N0,.4r"-,.)1
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.
ROUGH
I HEREBY CERTIFY AT I AM NO ACTING IN IOLA ION
OF CHAPTER 9, D"VISI N 3 OF THE BUS ESS D PR ESS NAL FINAL r-At— �
CODE OF THE STATE C LIFO R NIA.
s.IGNATURE PERMIT VALIDATION CK, M.O. CASH
OF PERMITTEE
PLAN.CHECK VALIDATION CK. M.0. CASH
9 9;p"_1 JUN .23 f 0 1 0.5 0