HomeMy Public PortalAbout9241 BLACKLEY ST_Mechanical__ .7 6 A 364 C E„8 1 8- 5-7 3
APPLICATION FOR PERMI
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES FBUILD17NGf EDEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION Jtl
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
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NO TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRESS 2p(q 12
ABSORPTION UNIT, BTU CITY TEL
CONTRACTO
AIR HANDLING UNIT, CFM
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BOILER, BTU CIT TEL NO
COMPRESSOR, BTU 2C 0I00 STATE LIC
LICENSE NO CLAS
VENTILATION SYSTEM DISTRICT NO GROUP ZONE PROC SED BY
EVAPORATIVE COOLER 8 �/
FURNACE FAU G VITY INSPECTION RECORD
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Plan check fee 25% oPabove See reverse Z
PERN9IT ISSUING FEE 8 ee-
TOTAL FEE,
PLAN CHECK APPLICANT
NAME �-
ADDRESS
CIT �e TEL NO1PROFESSIONAL
�1 HEREBY AC KNOW LEDG HAT I HAVE READ TIONANDSTATE THAT THE ABOVE IS CORRECT AND AGLYWITH ALL ORDINANCES AND LAWS REGULATING TI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING
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I HEREBY CERTIFY THAT I AM NOT ACTINION OF CHAPTER 9, DIVISION 3, OFTHEB NESS ANNAL FINAL
CODE OF THE STATALLDRNIA
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SIGNATURE PERMIT VALIDATION CK —M-o:.� CASH
OF PERMITTEE
PLAN CHECK VALIDATION CK M o CASH
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SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE CH