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76A364-CE818-1-68 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS p
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY
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FOR APPLICANT TO FILL IN
NEAREST
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(Print or type only) OWNER
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N O.. TYPE,OF APPLIANCE OR EQUIPMENT FEE
MAI L
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ABSORPTION SYSTEM, BTU CITY TEL. NO.
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AIR HANDLING UNIT, CFM CONTRACTOR J
BOILER, HORSEPOWER ADDRESSC1162 &al R.0
COMPRESSOR, HORSEPOWER.3 CITYr TEL. NO. gSlb ff j/
STATE LIC.
VENTILATION SYSTEM LICENSE NO CLASS C "Z
DISTRICT NO. GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER
FURNACE: FAU GRAVITY ..FLOOR—BTU `=' I [Y� L Ov
INSPECTION RECORD 17
HEATER: SUSPENDED—UNIT—
WALL
USPENDED UNIT
WALL ¢ p/ S 5' CD
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NEW—ADDITION— PERMIT $ 3 00
ALTER—REPAIR— TOTAL FEE $ �[>
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
HEATING, VENTILATING, AIR CONDITIONING.
IHEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL
CODE OF THE STATE OF CALIFORNIA. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNATURE r ROUGH
OF PERMITTEE
r. FINAL e,
JACK R. ALLEN
OIDATION
M.O. CASH SUPERVISING MECHANICAL ENG'R.
Lt �6 0 3 211:00 AUG 2 Q 4 1 D 11.00-
SEE
1.0ONSEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE