HomeMy Public PortalAbout9828 BROADWAY_Mechanical__ "3e4 - eBe,e ,,3 3-e9 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING �j -
DEPARTMENT OF COUNTY ENGINEER ADDRESS Q
BUILDING AND SAFETY DIVISION
JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY
COLEMAN W.JENKINS,SUPERINTENDENT OFBUILDING NEAREST
CROSS ST/��Z2�FIZ
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) ,�
MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
ABSORPTION SYSTEM, BTU CIT TEL. NO.
AIR HANDLING UNIT, CFM CONTRACTOR
ADDRESS
BOILER, HORSEPOWER
CITY TEL. NO.
COMPRESSOR, HORSEPOWER STATE LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER
FURNACE: FAU GRAVITY_
INSPECTION RECORD
FLOOR BTU
" HEATER: SUSPENDED UNIT-
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NEW_ADDITION_ PERMIT $ 3 00
ALTER--REPAIR_ TOTAL FEE s170
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL. NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATINGHEATING,VENTI- APPROVALS DATE IN ECTOR' S ATURE
LAT ING, AIR CONDITIONING.
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH /
CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL
L'
CODE OF THE STATE F CALIFORNIA. CQ
SIGNATURE �' JACK R. ALLEN, SUPERVISING MECHANICAL ENG'R.
OF PERMITTEE
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION
IG( „ 3 11 2- DEC 22 4 1 D 7.0Oµ
-E BACK 05 APPLICATION FOR COMPLETE FEE SCHEDULE