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76 A364 - CE 818 - 9-71 �APCATION FOR P MIT
HEATING - VENTILATING - AIR CON01 10URG
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COUNTY OF LOS ANGELES [NEAREST
7ESS
DEPARTMENT OF COUNTY ENGINEER r
BUILDING AND SAFETY DIVISION L
FOR APPLICANT TO FILL IN OWNER Me
(PRINT OR TYPE ONLY)
MAIL
NO TYPE OF APPLIANCEOR EQUIPMENT FEE ADDRESS
CITYP,k lC C & TEL NO
ABSORPTION UNIT, BTU
CONTRACTO
AIR HANDLING UNIT, CFM
ADDRESS j o GIL
BOILER, BTU /414
CITY , TEL NO
COMPRESSOR, BTU STATE LIC
LICENSE NO 21 CLASS
VENTILATION SYSTEM ��0/ 6 a DISTRICT NO GROUP ZONE CESSED BY
EVAPORATIVE COOLER
FURNACE R4,t1 GR V
F� BTU a t� v INSP CTION RECORD
HEATER SUSPENDED UNIT_
WALL v
W
A CL
U�1 N
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Plan check fee 255 of above See reverse
PERMIT ISSUING FEF, S 3 00
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO
LI HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
D STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYTH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DAT INSP CTOR'S SIGNATURE
TING, AIR CONDITIONING 04ROUGHHEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL
DE OF THE STATE O IF IAGNATURE PERMIT V DATION CK M 0 CASH
F PERMITTEE
PLAN CHECK VALIDAT N CK M 0 CASH
r,. 2 3 (5 97sA;2_:1 1 D 1 5 .504
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SCE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE