HomeMy Public PortalAbout9651 BROADWAY_Mechanical__ 'a 's"E'=" "B"' s"' APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
G LINTY OF LO NGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUILDING e� / ^
(PRINT OR TYPE ONLY) ADDRESS '04L
FOR y
NO. 'TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY /,
NEAREST
CROSSST.
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ABSORPTION UNIT,BTU
OWNER
AIR HANDLING UNIT,CFM MAIL 105-
I&WdADDRESS / C7 YC S^/ ,ln
BOILER,BTU
CITY oil"7j- AJ� TEL.NO. '
COMPRESSOR.BTU CONTRACTOR LC
VENTILATION SYSTEM ADDRESS [�. f3dx a G
EVAPORATIVE COOLER CITY'TII_ �.. `A�(. TEL.NO. Rrg 3SS
FURNACE: FAU GRAVITY STATELICENSE No. 7�/ t74:/` CILAXSS``
FLOORLIC
BTU.
HEATER: WUALLEND D �, UNIT— Dlsiq¢i NO. GROUP ZONE PROCESSED8
- INSPECTION RECORD
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Plan check fee 25% of above. W
PERMIT ISSUING FEE$ Y
TOTAL FEE —
PLAN CHECK APPLICANT
NAME
.ADDRESS
CITY TEL NO.
IHEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
ORDINANCES AND LAWS REGUI ING 'HEATINr VENTILATING. AIR
CONDITIONING. -
HEREBY CERTIFY HA AM NOT ACTING ! VIOLATION OF APPROVALS DATE msPE q's'si0rvaiu RE
CHAPTER 9. DIVISION 3. F .H BU - AND PR 'SSIONAL CODE d-a
OF THE STATE OF CALIFO' NI�. (// ROUGH
SIGNATURE' FINAL
OF PERMITTE
PLAN CH;EEIRS
ALIDATION CK. MO. CASH - PERMIT VALIDATION, cN. M.D- cnsH.
COMPENSATION .
44700 1541 0 ' 17.0 Q AN;
POLICY HOLDER:
POLICY NUMBER: )/U