HomeMy Public PortalAbout9123 BLACKLEY ST_Mechanical__ 76 A361,4 - CE BIB - 9-71 APPLICATION FOR PERMIT
+HEATING - VENTILATING - AIR CONDI IONING
COUNTY OF LOS ANGELES BUILDING >^� 1�
DEPARTMENT OF COUNTY ENGINEER ADDRESS /sa[ C
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
CITY TEL NO
ABSORPTION UNIT, BTU
CONTRACTOR
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU CITY TEL NO
COMPRESSOR, BTU STATE LIC
LICENSE NO CLASS
VENTILATION SYSTEM DISTRICT NO GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER -� i-0,
FURNACE FAUGRAVITY
FLOOR BTU INSPECTION RECORD
HEATER SUSPE D UNIT_ o
F-
WALL
w
a
Z
Plan cbeck fee 25% of above See reverse
PERMIT ISSUING FEE 8 s 00
7 OTAL FEE
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- APPROVALS DATESPECTOR'S SIGNATURE
EATING, AIR CONDITIONING
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISI 3, OF THE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STATE 0 ALIFOR NI a�
SIGNATUREPERMIT O ASH
OF PERMITTEE O
,PLAN CHECK VALIDATION CK M o CASH
O;: 7 0 0- 'ALJG28 4 Z D 8.00- 47
I
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE �.