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76.364C
CE 8181REV 6/78 1
ops c APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
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COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN FNEAREST
X30 7 &�oVl_
(PRINT OR TYPE ONLY)
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NO TYPE OF APPLIANCE OR EQUIPMENT FEE
ABSORPTION UNIT BTU
OWNER
AIR HANDLING UNIT CFM MAIL
ADDRESS
BOILER BTU CITY ,J TEL NO
COMPRESSOR BTU C 0 N T R A C T 0
VENTILATION SYSTEM ADDRESS I�l/(s 6//�°���r ,F✓(�/�
EVAPORATIVE COOLER �•`_✓ / / ,,7,721
CITY �.J(i/" yr/�L�'/TEL NO
FURNACE FAU GRAVITY STATE � /��j
FLOOR BTU / LICENSE NO��Tj pI
CASS �Y�
HEATER SUSPENDED UNIT_ APPROVALS DATE INSPECTOR S SIGNATURE
WALL
ROUGH
FINAL % f��� ���
INSPE TION RECO D L.7
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Plan check fee 25% of above
PERMIT ISSUING FEE Z
TOTAL FEE2
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PLAN CHECK APPLICANT CK VALIDATIONNAMEADDRESSCITY TEL NO
IHEREBY 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 VENTILATING AIR
CONDITIONING PERMIT VALIDATION �9_5 35'8 A
CHAPTERE9EBY DIVISEONI g THAT HE B SINE T ANDNG IN PROFESSIIONALON OF CODE # O 010 o 4 1
OF THE STATE OF CALIF A
SIGNATURE 2 O Io 1700
OF PERMITTEE �7
DISTRICT NO PROCESSED BY
OHO O 1 J 00
14 07 ,1/0-79
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