HomeMy Public PortalAbout9957 BROADWAY_Mechanical__ F• I I
4
76A364Q
CE-818(REV.6/78)
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILNG �' CJA w
ADDREDISSAq
(PRINT OR TYPE ONLY)
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY 7-
NEAREST
CR"'ST. e1A
o N
ABSORPTION UNIT,BTU
OWNER _
AIR HANDLING UNIT,CFM MAIL
ADDRESS
BOILER,BTU CITYTEL.NO,
COMPRESSOR.BTU CONTRACTOR `
VENTILATION SYSTEM t
ADORE ss4
DORE554 2 �� I T?q-
EVAPORATIVE COOLER CITY 4E 17-Y TEL.NOlB -Z
FURNACE: FAUGRAVITY STATE
FLOOR BTU LICENSE NO. CLASS C
HEATER: SUSPEIjI[J`ED jN T_ APPROVALS DATE N5PE�OR'5 SIGNATURE
( WALL •f ,ay_1, ✓• /0 0
ROUGH
7'
FINAL n O
INSP5TIEDN RECORD adU
O
Plan check fee 25% of above. \ :,\ •5 9
PERMIT ISSUING FEE$ z
TOTAL FEE
PLAN CHECK APPLICANT PLAN'CHECK VALIDATION
NAME
ADDRESS
CITY TEL.NO.
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL p
ORDINANCES AND LAWS REGULATING HEATINGVENTILATING. AIR
. 5 O J.7 A
CONDITIONING. PERMIT VALIDATION
I HEREBY CERTIFY THAT I AM NOT A ING IN VIOLATION OF # 0 0 0 0 [I 1
CHAPTER 9. DIVISION 3, OF THE INESS D PROF SSIONAL CODE
OF THE STATE OF CgLIygRN A. I O O 17.00 7.OO
SIGNATURE
OF PERMITTEE L
DISigICT NO [Rogya_p. 8 4 1 7'O OF,0621 -79