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APPLICATION FOR PERMIT `Lt�
• HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
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DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS, SUIPIRRINTENDENT OF BUILDING NEAREST I
CROSS ST
FOR APPLICANT TO FILL IN, OWNER /
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NO YPE OFAPPLIA NCE OR EQUIPMENT FEE n
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ABSORPTION SYSTEM BTU CITY ` C-L TEL No - 3 6
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AIR HANDLING UNIT, CFM ...
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BOILER HORSEPOWER CIT�A„T'� FE c1PQ-LNGTEL NO �TL-Q 6
COMPRESSOR, HORSEPOWER STATE ? LIC ,�yy
LICENSE NO —6 / CLASSL_-ZG
VENTILATION SYSTEM DISTRICT
\TT No CLASS GROUP \`ZONE PROCESSED BY
EVAPORATIVE COOLER �' Vffl I 2 '//
FURNACE FAU_GRAVITY INSPECTION RECORD
FLOOR BTU
HEATER SUSPENDED�UNIT �JO /177 T
WALL J VV
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NEW—ADDITION_ PERMIT S 3 00 ?
*LTER_R EPAIR_ TOTAL FEE $
PLAN CHECK APPLICANT
NAM14 ti
ADDRESS Z ` L ✓
CIT X10 2.TM6 TEL N062
I MEREST ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AOR[[ TO COMPLY
WITH ALL ORDINANCES ANO LAWS REGULATING HEATING VENTI APPROVALS DATE INS ON'!SIGNATURE
LATING, AIR GOND IT IONINO
ROUGH
I HERESY CERTIFY THAT I AM NOT ACTINO IN VIOLATION
OF CMAPTlR 0 OI VI p10 9 H! BUl IN[SS AN P.OFESSI L FINAL
COD[ OP THE STATE C RMIA
SIGNATUROF PERMIET JACK R ALLEN,SUPERVISIN �.1 C I L ENG•R
PERMIT VALIDATION cK CASH
PLAN CHECK VALIDATIbN
tJto 7 S: DEC 21 a 1 D 3300-
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SE[BACK OP APPLKATION FOR COMPLETE IEC SCHEDULE