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76A36;-CEa,8-1/7D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT-OF COUNTY ENGINEER
BUILDING,AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING NEAREST
� CROSS ST.
FOR APPLICANT TO FILL IN
(PRINT OR TYPE ONLY) OWNER ��
MAIL T �/ �/
NO. TYPE OFAPPLIA /
APPLIANCE EQULPMENT FEE ADDRESS eie '
CITY C I` TEL. NO. .��
ABSORPTION SYSTEM, BTU [[[[[[CCCCCC l `
CONTRACTOR , 1 .
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, HORSEPOWER CITY `2 TEL. NO.
COMPRESSOR, HORSEPOWER STATE LIC.
LICENSE NO. � CLASS
VENTILATION SYSTEM DISTRICT NO. CLASS GROUP, ZONE PROCESSED BY
EVAPORATIVE COOLER �� ��j ✓ rode
FURNACE: FAU_GRAVI-TY
FLOOR BTU OINSPECTIN RECORD
EA?EF3:®S P UNIT �O
�w a 7
o
U
O
H
NEW -ADDITION PERMIT' $ .3 00 a
N
ALTER REPAIR-
TOTAL FEE' $: L�
PLAN CHECK APPLICANT,
.
NAME
ADDRESS
CITY TEL,NO.
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ,
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS ' TE PECTOR'S SIGNATURE
LATING, AIR CO
ROUGH
I HE Y CERTIFY T AT I AM NO G IN VIOLATION
OF CHAP ER 9, DMS OF THE B N AND PR FES - AL FINAL 1'
CODE OF STATE F LIFOR NIA.
SIGNATURE JACK R.-ALLEN,SUPERV��71K?.
HANICAL ENG-R.
OF PERMITTE
74 PERMIT VALIDATION M.O. CASH
PLAN CHECK VAL ATIO
011
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE -