HomeMy Public PortalAbout9520 BLACKLEY ST_Mechanical__ 7eA3e4 - ceBle - 3-69 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING,
COUNTY OF LOS ANGELES fBUILDING »1/i�/L��/ C�-
DEPARTMENT OF COUNTY ENGINEER ESS �Gr��/► L//,�f�� l c�
JOHN AING AND LAMBIES COUNTY ENGIINEEER AFETY DIVISION
LITY
COLEMAN W JENKINS,SUPERINTENDENT OF BUILDINGESCROSS ST. , �LDU62L,
FOR APPLICANT TO FILL IN OWNER /(f/ZZ' C.
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
ABSORPTION SYSTEM, BTU CITY ,,�� 11 A, ``TEELL NO
AIR HANDLING UNIT, CFM CONTRACTOR oLo/o C
ADDRESS
BOILER, HORSEPOWER
CITY TEL. NO.-
COMPRESSOR, HORSEPOWER S O
LICENSE NO
STATE LIC.
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE SSE By
EVAPORATIVE COOLER O -Z'
CLASS/
FURNACE- FAU GRAVITY
FLOOR BTU �"rL/1 D6G INSPECTION RECORD
HEATER: SUSPENDED UNIT
WALL >-
a
0
w
0
V
w
a
NEW_ADDITION_ PERMIT $ 3 .00 Z
ALTER_REPAIR_ TOTAL 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 TE PECTOR'S SIGNATURE
LATING, AIR CONDITIONING.
I HEREBY CERTIFY THAT 1 AM NOT ACTING IN VIOLATION OF ROUGH
CHAPTER 9, DIVISION 3, OF THE BUSINESS AND pfjpFESSIONAL FINAL -
CODE OF THE STATEA� /KI//'rN/�]C_.�
SIGNATURE . JACK R. ALLEN, 'SUPERVISING MECHANICAL A�CAS.OF PERMITTEE PERMIT VALIDATION CK. M.O.
PLAN CHECK VALIDATION
Ifo 9 5 N t ,t� 16 4 1 D 1 5.5 ON
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE - '