HomeMy Public PortalAbout5234AGNES AVE_Mechanical (3) 76A364- C'E818 - 3 69 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES FADDRESS
DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION'
JOHN A LAMBIE COUNTY ENGINEER COLEMAN W JENKINS SUPERINTENDENT OF BUILDING ro
FOR APPLICANT TO FILL IN lJGZ��
OWNER
(PRINT OR TYPE ONLY)
MAIL
NO TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS ✓2 QyG/
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ABSORPTION SYSTEM BTU CITY NO
CONTRACTO
AIR HANDLING UNIT CFM
ADDRESS
BOILER HORSEPOWER
CITY L NO
COMPRESSOR HORSEPOWER STATELIC/
LICENSE NO S~(�� CLASS �V
VENTILATION SYSTEM DISTRICT NO GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER
FURNACE FAU GRAVITY d
FLOOR BTU a7-J (,7D INSPECTION RECORD
HEATER SUSPENDED UNIT }
WALL c-
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NEW_ADDITION_ PERMIT $ 3 00
ALTER_REPAIR_ TOTAL FEE $ op
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO
I HEREBY 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
LATING AIR CONDITIONING APPROVALS D TE WIPECTOR 5 SIGNATURE
I HEREBY CERTIFY THAT I AM NOT ACTING I IOLATION OF ROUGH
CHAPTER 9 DIVISION 3 OF THE BUSINESS OFESSIO FINAL
CODE OF THE STATE LIF R A
SIGNATURE JACK R ALLEN SUPERV ECHANICAL ENG R
OF PERMITTEE
PERMIT VALIDATION cK k 0 CASH
PLAN CHECK VALIDATION
.00'E ,�. 2 (),4-6r---' AUG 2:5 4 4 D 8.00-
EE
E BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE r y