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zG A3o4 - EE 91B - 9-11
APPATION FOR MIT
HEATING - VENTILATING - A R CONDITION NG
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COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY .i
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL g
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
CITY TEL. NO.
ABSORPTION UNIT, BTU
CONTRACTOR
AIR HANDLING UNIT, CFM
ADDRESSJS—/
BOILER, BTU
CITY -A TEL. NO.
COMPRESSOR, BTU STATE G�S/✓ c CAS /� /
LICENSE NO.
VENTILATION SYSTEM DISTRICT No. GRouP NE PRa CE ED BY
EVAPORATIVE COOLER OB ii
FURNACE: FAU_GRAVITY
FLOOR BTU INSPECTION RECORD
s
HEATER: SUSPENDE _UI IT
WALLS W
d
N
Z
flan check fee 25' of above. See reverse.
PERMIT ISSUING FEE S 3 OD
TOTAL Ff,E
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
1 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 SPECTOR'S SIGNATURE
LATINS, AIR CONDITIONING, w
5
IHEREBY CERTIFY THAT 1 AM NOT ACTING IN VIOLATION ROUGH /
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AN PROF SIGN} FINAL 2 Z �6
CODE OF THE BT OF CACIP 11 NIA. CeC /// _
SIGNATURE � PERMIT VA I ATION CK. M.o. CASH
OF PERMITT
PLAN CH CK VALIDATION Dr M.D. CASH
(9525+3 MAR 1341YYYID 800
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE