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78AMIZEE CE818B-975 � APPLICATION FOR PERMIT
HEATING '- VENTILATING - AIR CONDITIONING
BUILDIN AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUILDING 45 j /o
t ' (PRINT OR TYPE ONLY) - ADDRESS
LOCALITY
NO TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST
CROSS ST
ABSORPTION=UNIT, BTU
' OWNER b Q 1 q
AIR HANDLING UNIT, CFM MAIL, q
ADDRESS S / C�c 't
BOILER, BTU' CITY TEL NO
COMPRESSOR, BTU CONTRACTOR
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VENTILATION SYSTEM` ADDRESS
EVAPORATIVE COOLER CITYUt exTEL N07-4 X_JL8
FURNACE FAUGRAVITY STATE e, LIC
FLOOR BTU LICENSE NO .� 3�J y �— CLASS
HEATER SUSPENDED UNIT_ DISTRICT No GROUP ZONE EssED BY
WALL "ts'eo ,
INSPECTION RECORD
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Plan check fee 25% of above
PERMIT ISSUING FEE $
TOTAL FEE Q O
PLAN CHECK APPLICANT
NAME
ADDRESS 0 /:r- ra �,<I� �
CITY 6 /\ TEL NO 7I-)'kl�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ` t
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALLORDINANCES AND LAWS REGULATING HEATING VENTI-
LATING AIR CONDITIONING
t
IHEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION APPROVALS DATE INSPECTOR'S SIGNATURE
OF CHAPTER 9 O,IVISION 3 OF THE BUSINESS AND PROFESSIONAL
CODE OF THE STATE OF RNI ROUGH
SIGNATURE 'n_�9 "
OF PERMITTEE 1 FINAL 2
PLAN CHECK VALIDATION PERMIT VALIDATION ' K , M O CASH
CK M 0 CASH
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0 8 4 7 4 1, 0` 1 2.0 0 A
76 A364- CE BIB- 5-73 f
�CAFOR MIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER
ADDRESS
BUILDING AND,SAFETY DIVISION LOCALITY1
NEAREST 421
CROSS ST
FOR APPLICANT TO FILL IN OWNER
S (PRINT OR TYPE ONLY) - e
MAIL
No TYPE OF APPLIANCE OR EQUIPMENT FEE
ADDRESS ♦ I �ov c moi.♦
CITYTEL NO
ABSORPTION UNIT, BTU
CONTRAC OR
AIR HANDLING UNIT, CFM - gDDRESS_��
BOILER, BTU CITY r�I?aJ� t TEL NO,71_J'2_�,.L 91
COMPRESSOR, BTU STATE LIC LICE SE NO `7 CLASS
VENTILATION SYSTEM' DISTRICT NO GROUP OONE PCESSED BY
EVAPORATIVE COOLER U —�
FURNACE FAU_GRAVITY Q
FLOOR—BTU ' INSPECTION RECORD
HEATER SUSPENDED—UNIT—
WALL
USPENDED UNIT_WALL �.
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CO01-
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Plan check fee 25% of above See reverse
PERMIT ISSUING FEE S 3 00 1
TO]AL FEE U
PLAN CHECK APPLICANT
NAME ss 1j �I�fhl1 ) J o-
A DDRESS az (� �"L !j •-Y l IL1rt _ '
CITY j"lip ', f�f\ TEL NO -nla'L
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION '
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALLORDINANCES AND LAWS REGULATING HEATING, VENTI- . APPROVALS DATE INSPECTOR'S SIGNATURE
LATING AIR CONDITIONING
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION '
OF CHAPTER 9 DIVISIO F THE BUSINESS AND PROFESSIONAL FINAL 7_ 1
CODE OF THE STATE C OR NIA �`
sI GNAT URE PERMIT VALIDATION cK M 0- CASH
OF PERMITTE
PLAN CHECK VALIDATION CK M 0 CASH
0"7 1 .',AY �0 4'1 D 8.0 0 a,-o
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE ,