HomeMy Public PortalAbout6057 CLOVERLY AVE_Mechanical__ 76 A364 -"CE 818-1/75
APPLICATI FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES ADDRESS ( (� aIU pw
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY, E
NEAREST
CROSS ST. CL II,- i
FOR APPLICANT TO FILL IN OWNER 7�:
(PRINT OR TYPE ONLY)
MAIL
N0. TYPE&SIZE OF EQUIPMENT FEE ADDRESS (0tO C1!/(�v"
SEE BACK OF APPLICATION
FORCE AIR FURNACE, BTU /tlM CIT/010 Privy — i� EL. NO.
A� ' [ `! Q
COMPRESSOR, BTU 3 � M CONTRACTOR l% AMC
ADDRESS _ Ca 4r ewe eo_
VENTILATION FAN CITY / TEL. NO.
LIST ALL OTHERS BELOW STATE LICE SE NO. f tS� 6 CLASS
DISTRICT NO. GROUP [�NE CE SSED BY
6-1 vS I
INSPECTION RECORD
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Plan check fee. See reverse.
11I.R.NII'1' ISSIAN FEE c
r
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I 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 DATE INSPECTOR'S SIGNATURE
LAT ING, AIR CONDITIONING.
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF THE B INESS AND PROFESSIONAL FINAL
CODE OF THE STATE OF CALIFO NIA.
SIGNATURE PERMIT VALIDATION CK. M.O. CASH
OF PERMITTEF�
PLAN CHECK VALIDATION CK. M.O. CASH
7 4 0 0 nCT 18 4. 1 9.5 0
0 vp