HomeMy Public PortalAbout5028AGNES AVE_Mechanical (2) rdA1164-CE�-B1B'-B Ee APPLICATION FOR PERMIT C1
} HEATING - VENTILATING - AIR CONOITIONING7U
COUNTY OF LOS ANGELES / �[ T
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FAOD7RESS,
JOHN A LAMBIE COUNTY ENGINEER COLEMAN W JENKINS SUPERINTENDENT OF BUILDINGNEAREST
FOR APPLICANT TO FILL IN
(Print or type only)
OWNER
NO TYPEJOF APPLIANCE OR EQUIPMENT FEE
MAIL
ADDRESS
ABSORPTION SYSTEM BTU CITY TEL NO
AIR HANDLING UNIT CFM CONTRACTOR jg y
BOILER HORSEPOWER ADDRESS C1 Z 50 j
COMPRESSOR HORSEPOWER CITY 4 ',�C,4, 3 Z TEL NO 2,f$
STATE LIC
VENTILATION SYSTEM LICENSE NO CLASS C 9;7-O
EVAPORATIVE COOLER
DISTRICT NO GROUP ZONE PROCESSED BY
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FURNACE FAU G VITY �7 �
FLOOR-BTU 0 lJ INSPECTION RECORD
HEATER SUSPENDED UNIT
WALL
C-
o_.
O
U
O
H-
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W
CL.
N
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NEWADDITION PERMIT $ 3 00
ALTER—REPAIR— TOTAL FEE $ O
Plan check applicant
Name
Address
City Tel No
I 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 PATE1 VECTOR NATURE
LATING AIR CONDITIONING -I
ROUGH t 3
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION FINAL
OF CHAPTER 9 DIVISION 3 OF THE BUSINESS AND PROFESSIONAL ry
CODE OF THE STATE OF CAVIFORNIA
JACK R ALLEN VIPF65ING MECHANICAL ENG R
SIGNATURE
OF PERMITTE PERMIT VALIDATION crc M O CASH
PLAN CHECK VALIDATION
( PIr'r9 62 4w APR2US 4 1 0 7 00~
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE