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76A364-C"E818-1/70 APPLICATION FOR PERMI [�
HEATING - VENTILATING - AIR CONDITIONING I I
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING AAA
CROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) _
MAIL
NO. TYPEOFAPPLiANCE,OR EQUIPMENT FEE ADDRESS
CITYr TEL. NO. S 41
ABSORPTION SYSTEM, BTU /-//"
CONTRACTOR
AIR HANDLING UNIT, CFM � ,
ADDRESS
BOILER, HORSEPOWER CITY ` TEL. NO.
COMPRESSOR, HORSEPOWER STATELIC.
LICENSE NO. lc')_
`iCLASS /
VENTILATION SYSTEM DISTRICT NO. CLASS GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER
FURNACE: FAU_GRA_V1TY
FLOOR BTU OZ' INSPECTION RE CI D
HEATER: SUSPENDED UNIT_
WALL
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NEW_ADDITION PERMIT $ 3 00 Z
ALTER-REPAIR- TOTAL FEE $ A
PLAk CHECK P ANT W
NAME
ADDR S ,DG gzyo
CITY TEL.NO. O S4)
I H REBY 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 D TE IN ECTOR'SSIGNATURE
LATING, AIR CONDITIONING.
ROUGH .�
1 HEREBY CERT Y T T 1 AM NO A ING IN VIOLATION
OF CHAPTER 9, DIVI ION 3, F THE BUS NES NO PRO SSIONAL FINAL
CODE OF THE STATE F CALI O ` 14�J
SIGNATURE / JACK R. ALLEN,SUPERVISING MECHANICAL ENG-R.
OF PERMITTEE p
PERMIT VALIDATION tCK."7 m.o. CASH
PLAN CHECK V LIDATION -�
Ar5 4 4 3c' HAR30 4 -1 D 13-00-
SEE
3.00NSEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE