HomeMy Public PortalAbout5734 CLOVERLY AVE_Mechanical__ CE+8,181REW6/78) . , ti ' s " , '3 • 'rF
APPLICATION FOR PERMIT .r -
'HEATING - VENTILATING— AIR CONDITIONING �
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COUNTY OF LOS ANGELES'S BUILDING'AND,SAFETY r _
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FOR APPLICANT TO FILL IN ADD '
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INSPECTION RECORD V
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Plan check fee 25% of above
PERMIT'ISSUING'FEE$ r `'7 a tJ - _ n, z
TOTAL FEE ,
PLAN CHECK APPLICANTr _ PLAN CHECK VALIDATION
NAME
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ADDRESS
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,CITY TEL'NO � '^1 1+2 A
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI TION AND ' r
STATE THAT THE ABOVE IS CORRECT.AND AGREE TO COM Y WITH ALL + _ y i r [ O o 10'0'[, 1 e
ORDINANCES AND LAWS REGULATING H�ATNG V ILATING' AIR- t '
coNDInoNING �1 PERMIT VALIDATION 1' ' 1+3i �'�;
I HEREBY%C IFY TH T I AM NOTJ�JN
VIOLATION OF ° w �; - f�CHAPTER 9 DTVI ON 3 0 HE BUSINE SSIONAL CODE ,+ "'o 0 o11 0 V�.J
OF THE STATE OFPAAIFOR
SIGNATURE 05 0 1,1
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OF PERMITTEE , , r k^ T
DISTRICT NO PROC S D BY
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76 A36\i
CE 818-1/75
APPLICATION FOR PERMIT r
HEATING; VENTILATING-=FAIRC0N01110NING
COUNTY OF LOS ANGELES BUILDING
ADDRESS aJ
DEPARTMENT OF COUNTY ENGINEER _
BUILDING'AND SAFETY DIVISION LOCALITY ?
NEAREST �1
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CROSSST „
FOR APPLICANT TO FILL IN
OWNER
(PRINT OR TYPE ONLY)',
MAIL'
NO TYPE&SIZE OF EQUIPMENT` " FEE ' ADDRESS bf
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SEE BACK OF APPLICATION £ - ,
CITY —� TEL NO
FORCE AIR FURNACE BTU
CONTRACTORS
r ADDRESS ' r '
VENTILATION FAN CITY TELA yN0
LIST ALL OTHERS BELOW STAT LI �j/p
LICENSE NO CLASS( 4AL "
F . r DISTRICT NO ' °" GROUP ZONE ESSED BY
`*v a INSPECTION RECORD i
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Plan check fee See reverse Q z
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PLAN CHECK APPLICANT Y
NAME z, A
ADDRESS
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THEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION,
AND STATE'zTHAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING VENTI- APPROVALS EDAT INSPECTORS SIGNATURE ,
LATING, AIR CONDITIONING ' e
" ROJGH
1 HEREBY CERTIFY AT I A OT + TING IN VIOLATOON
OF CHAPTER 9 DIVIS N 3 OF BU S A PROFESSIONAL FINAL _1
CODE OF_THE-STATE F,CA IF A -
SIGNATURE - /:'— PERMIT VALII"DATION K 1 'M O .y -CASH
OF PERMITTEE, 77 ;
PLAN CHECK ALIDATION CK M o cases
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