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APP
HEATING - VENTILATING - IR CONDITIONING
COUNTY OF LOS ANGELES BUILDING r'
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALIT
NEAR EST '
CROSS ST
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRESS
71
CITY T L NO
ABSORPTION UNIT, BTU
CONTRACTO
AIR HANDLING UNIT, CFM
ADDRESS � � �,
BOILER, BTU � / /i6)
CITY EL NO !>G
COMPRESSOR, BTU STATE LIC /'l7
LICENSE NO CLASS
VENTILATION SYSTEM DISTRICT NOOGGRR^OUP ZONE ESSED BY
EVAPORATIVE COOLER
Oh
f� /✓I_/
FURNACE FAUGRA I Y C/
FLOOR BTU Gd INS PE TION RECORD
HEATER SUSPENDED UNIT_
WALL w
a
Z
I
Plan check fee 25% of above See reverse
PERMIT ISSUING FEE S 3 00
'1 OTAL FEE -1306
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 DfTE INS ECTOR'SNATURE
LATING, AIR CONDITIONING
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTIN IN VIOLATION
OF CHAPTER 9, DIVIS OF THE USIN ESS
P FESSION,�L FINAL 'L
CODE OF THE STA OF C I /f//�j
SIGNATURE / PERMIT VALIDATION cK ! M 0 CASH
OF PERMIT
PLAN CHEC VALIDATION CK M 0 CASH \„
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE