HomeMy Public PortalAbout9247 BLACKLEY ST_Mechanical__ 76A364E-LSE 818A) 11/76 APPLICATION FOR PERMIT
HEATING,- VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
r BUILDING AND SAFETY DIVISION t,
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FOR APPLICANT TO FILL IN BUILDING
(PRINT OR TYPE ONLY) ADDRESS
LOCALITY 7 -
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROSS ST
ABSORPTION UNIT BTU
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AIR HANDLING UNIT CFM MAIL
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BOILER BTU CITY�rs `, TEL NOJ���'���
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COMPRESSOR BTU CONTRACTORT
VENTILATION SYSTEM ADDRESS S'`.j��.p�I
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FURNACE FAU RAVITY STATELICENSE NO Yd CLASS
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FLOOR BTU
HEATER SUSPENDED UNIT- DISTRICT NO GROUP
WALL ZONE ROCFjEDeY
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INSPECTION RECORD 4
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Plan check fee 25% of above
PERMIT ISSUING FEE$
TOTAL FEE _
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY r 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
I HEREBYCERTIFY THAT I AM NOT ACTING IN VIOLATION OF APPROVALS DATE INSPECTOR S SIGNATURE
CHAPTER 9 DIVISION 3 OF THE BUSI ESS AND PROFESSIONAL CODE
OF THE STATE OF CMOPI ROUGH
SIGNATURE FINAL �-
OF PE RMITTE
PLAN CHECK VALIDATION CK MO CASH PERIWIT VALIDATION CK Mo CASH
1,3 Zr'--JUU 22 4 1 ® 1 9.5 0
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