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76A364.,7 CF#81*,— 3-69 APPLICATION FOR PERMIT
HEATING --VENTILATING - AIR CONDITIONING D C;?,<>,-
COUNTY OF LOS ANGELES f
LDING O
DEPARTMENT OF COUNTY ENGINEER RESS
BUILDING AND SAFETY DIVISION '
JOHN A. LAMBIE, COUNTY ENGINEER ALITY
COLEMAN W JENKINS,SUPERINTENDENT OF BUILDINGREST
SS ST.
FOR APPLICANT TO FILL IN `
(PRINT OR TYPE ONLY) OWNER —
MAIL
NO: TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS !�
ABSORPTION SYSTEM, BTU CITY TEL. NO a0
AIR HANDLING UNIT, CFM CONTRACTOR
ADDRESS
BOILER, HORSEPOWER
CITY TEL. NO.
COMPRESSOR, HORSEPOWER STATE LIC
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP 'ZONE PROC SED BY
EVAPORATIVE COOLER U :r �f -d
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FURNACE. FAU GRAVITY �p�
FLOOR BTU 00 INSPECTION RECORD
HEATER: SUSPENDED UNIT >•
WALL 0-
0 0
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0
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NEW—ADDITION— PERMIT $ 3 00
ALTER--REPAIR_ TOTAL FEE $
PLAN CHECK APPLICANT ,
NAME
ADDRESS _
CITY TEL NO.
IHEREBY ACKNOWLEDGE THAT 1 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
LATING, AIR CONDITIONING. '
I HEREBY C T'FY
THAT I AM NOT ACTING IN VIOLATION OF ROUGH
CHAPTER 9, D ISION 3, OF THE BUSINE ND PROFESSIONAL FINAL
CODE OF THE S ALIFORNI
SIGNATURE JACK R. ALLEN, SUPERVISING MECHANICALENG'
OF PERMITTEE
PERMIT VALIDATION ' CK. M.O. CASH
PLAN CHECK VALIDATION
6-2c- -AUG11 4 1 D 7.00 - a
'EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE