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;6A364 - CEB18 - 3-69 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BU7T ,
DEPARTMENT OF COUNTY ENGINEER AD
BUILDING AND SAFETY DIVISION r�
JOHN A. LAMBIE, COUNTY ENGINEER LO
t�OLEMAN W.JENKINS,SUPERINTENDENT OF BUILDING NE
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FABS
APPLICANT TO FILL IN OWNER 1/12J�
(PRINT OR TYPE ONLY)
MAIL
F APPLIANCE OR EQUIPMENT FEE ADDRESS
PTION SYSTEM, BTU CITY _ "' TEL. NO
CONTRACTOR
NDLING UNIT, CFMADDRESS
, HORSEPOWER
CITY TEL. NO.
ESSOR, HORSEPOWER STATE LIC.
LICENSE NO. CLASS
ATION SYSTEM DISTRICT NOO. GROUP ZONE PROCESSED BY
RATIVE COOLER or
CE: FAU GRAVITY
FLOOR BTU INSPECTION RECORD
HEATER: SUSPEWED UNIT
WALL
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NEW-ADD ITION_ PERMIT S 3 00 Z
ALTER--REPAIR_ TOTAL FEE $
[L'AN CHECK APPLICANT
AME
DDRESS
ITY TEL. NO.
I HEREBY ACKNOWLEDGE THAT 1. HAVE READ THIS APPLICATION
ND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
ITH ALL ORDINANCES AND LAWS REGULATING HEATING,VENTI- APPROVALS TE SPECTO SSIGNATURE
ATING, AIR CONDITIONING.I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH
HAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONALFINAL
ODE OF THE STATE ALIFO 1INATURE (� JACK R. ALLEN, SUPERVI ECHANICAL ENG'R.
F PERMITT
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION
2 4 62C &L 6 4 1 D 8.00-
SEE
.00 SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE