HomeMy Public PortalAbout4817 DOREEN AVE_Mechanical__ 23.A3 6_.CE 818 - 9-71Al"FICrATIDN FORMIT
HEATING VENTILATING IR CONDITIONING
COUNTY OF LOS ANGELES ADDRESS / Pe,i, iz //-✓��
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY
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NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS OV�E'eG
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ABSORPTION UNIT, BTU CITY TEL. NO.
CONTRACTOR Wit- i Is /uw ll
AIR HANDLING UNIT, CFM
ADDRESS !' t°,jiai+;C
BOILER, BTU '
CITY l'v L7/r�� TEL. NO. �p
COMPRESSOR, BTU STAT LIC.
LICENSE NO. �� CLASS C J
VENTILATION SYSTEM DISTRICT NO. GROUP //,IONE Cessw By
EVAPORATIVE COOLER egg
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6
FURNACE: FAUGRAVITY
FLOOR BTU INSPECTION RECORD V
/ HEATER: SUSPENDED_UNIT LPO
WALL cD
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Pl:m check fee 2550 Of eboze. See reverse.
I"ER\IIT ISSUING FEE, S 3 00
1I'0'I'AL. FLE O�j
PLAN CHECK APPLICANT
E
SS TEL.NO.
REBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONTE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYLL ORDINANCES AND LAWS REGULATING HEATING. VENTI- APPROVALS DATE IN PECTOR'SSIGNATURE
AIR CONDITIONING.
ROUGH
EREBY CERTIFY THAT I AM NOT ACTING IN VIOLATIONTER 9. DIVISION 3, OF THE USINE S AND PROFESSIONAL FINALF THE STATE OI CALIFOR NI�.TURE /{ PERMIT VAL TIO cKM.O. CASH
RMITTEE_[
PLAN CHECK VALIDATION
CK. M.O. CASH
.7
i �r 3 4 C 213 UGI 1 a D 8.004
SEE BACK OF APPLICATION FOR COM PLETE_FEE SCHEDULE