HomeMy Public PortalAbout9683 BLACKLEY ST_Mechanical__ 7b A36.4.1%,CE 818 e9_71. .. APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES ADDRESS
DEPARTMENT OF'COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY —'�
N EAR EST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER e
(PRINT OR TYPE ONLY) "� /'�'Ci /' ��� 'r•Cr'�
MAI L l
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
TEL. NO. ��
ABSORPTION UNIT, BTU
CONTRAC OR
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 —/
FURNACE: FAU_iPT GRAVITY INSPECTION RECORD v
FLOOR BTU 0CIO
HEATER: SUSPENDED —UNIT_ O
H
WALL w
Z
Plan check fee 25% of above. See reverse.
PERMIT ISSUING FEE $ 3 00
TOTAL FEE f�
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 ORDINANCESAND 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, DIVISION 3, O THE BUSINES AND PROFESSIONAL FINAL
CODE OF THE STATE OF CAL OR NIA. 0�
SIGNATURE PERMIT VALIDATION CK. M.0. CASH
OF PERMITTEE
PLAN CH CK,XALINATION CK. M.O. CASH v J
'3 7 194 1 1 U.5 U
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE