HomeMy Public PortalAbout9306 BLACKLEY ST_Mechanical__ 76 A364 -•CE 818-1/75
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING / �, C
DEPARTMENT OF COUNTY ENGINEER ADDRES �v
BUILDING AND SAFETY DIVISION LOCALIT;;'�
NEAREST
CROSS ST
FOR APPLICANT,TO FILL IN OWNER
(PRINT OR TYPE ONLY) MAIL e
NO TYPE&SIZE OF EQUIPMENT FEE ADDRESS
SEE BACK OF APPLICATION i
CITY ('- "'f' TEL NO
FORCE AIR FURNACE, BTU
CONTRACT0 n
COMPRESSOR, BTU ADDRESS ,A/ S �s AJ
VENTILATION FAN CITY TEL NO `
3`/' S Cid
LIST ALL OTHERS BELOW STATE LIC
LICENSE NO
DISTRICT NO GROUP 70 P OCE ED BY
INSPECTI E0RD
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Plan check fee See reverse z
10'I 41 I-1--i
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO
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1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALLORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE . INSPECTOR'S SIGNATURE
LATING AIR CONDITIONING
ROUGH _
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVIS 3 OF THE BUSINESS AND PROFESSION FINAL Y�
CODE OF THE STAT CALIFORNIA
SIGNATURE PERMIT VALIDATIO t4 M 0 CASH
OF PERMIT
PLAN CF11FICK VALIDATION CK M D CASH
02 nv 5 4 1 7.5 G,��