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76 A364 - CE 818 - 9-71 APPLICATION FO PERMIT
•- - HEATING - VENTILATING - AIR CONOITIO ING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST C
CROSS ST
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS i i
r
CITY TEL O
ABSORPTION UNIT, BTU
CONTRACT
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU
CITY TEL NO
COMPRESSOR, BTU STATE LIC
LICENSE NO Q CLASS
VENTILATION SYSTEM DISTRICT No GROUP ZONE 7SSED By
EVAPORATIVE COOLERci-
FURNACE FAU_GRAVITY O
FLOOR BTU INSPECTION COR v
HEATER SUSPENDED UNIT_ f o
WALL `� _"' w
CL.
to
Z
Plan check fee 257o of above See reverse
PERM[I' ISSUING FEE S 3 00
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO
I L
BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
E THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DA IN CTOR'S SIGNATURE
IR CONDITIONING
ROUGHEBY CERTIFY THAT I AM NOT ACTING IN VIOLATIONER 9, DIVISION 3, OF THE BUSINESS AN 'PROFESSIONAL FINAL
HE STATEO 0 NIA
RE PERMIT VALID ION K M O CASH
MITTEE 7
PLAN CHECK VALI A! ON CK M o CASH 4111
f �1 4 1 0 8.c �}n
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SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE - ,