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AP ICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING �LJI
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER A,
(PRINT OR TYPE ONLY)
MAIL p� /
N0. TYPEOFAPPLIANCEOR EQUIPMENT FEE ADDRESS /-
CITYLTEL. NO.
/CEM
ABSORPTION UNIT, BTU
'
CONTRACTOR C
AIR HANDLING UNIT, CFM
ADDRESS O
BOILER, BTU yy� CITY /� TEL. NO�(/' � /Q
COMPRESSOR, BTU --L'/ e6 STA I n)oole LIC.LICENSE NO. Cry CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE Pfl sSED BY
EVAPORATIVE COOLER
FURNACE: FAU_GRnv y7� U
INSPECTION RECORD
FLOOR BTU_
HEATER: SUSPENDED—UNIT _�2,Q 3 I OL U
WALL w
d
Z
w, 1sT i/-6 -26
Pian check fee 25'1 oI above. See reverse.
PEWMIT ISSUING. FEE S 3 00
IOTA 1, FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
v
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION \ /
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY '
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS Y/DA NSPECTOR'S SJGNATURE
LATING, AIR CONDITIONING. N
ROUGH
HEREBY CERTIFY i 1 AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3,, O OF THE BUSIN 55 AND PROFESSIONAL FINAL
CODE OF THE STATE O ALIFOR A
SIGNATURE OF PERMITTEE_ PERMIT VALIDATION CyI: M.w cases
PLAN CHECK VALIDATION CK. M.0. CASH
A( 2 5 0 973 JUL -70 4 1 0 1 5 ,50A
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE