HomeMy Public PortalAbout5723 ENCINITA AVE_Mechanical__ 76 A36E CE 012 -1'75
APPLICAdJION FOR PERT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE`GNLY)
MAIL `
NO. TYPE&SIZE OF EQUIPMENT FEE ADDRESS y
SEE BACK OF APPLICATION
CITY TEL. NO.
FORCE AIR FURNACE, BTU " r
CONTRACTOR
3 —
COMPRESSOR, BTU ADDRESS
} 7
VENTILATION FAN CITY a TEL. N2
f 3
LIST ALL OTHERS BELOW STATE IdLTC. '
LICENSE NO. A, CLASS
..ISTRICT NT, "FIT, .NE Rx ESSEO By
_
INSPECCO RE COR �
U
w
J
LL
_ y
a
-- K
0
a
I �
w
Plan check fee. See reverse.
111:1\11'11s�I ISG I, I I S 3 00
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY —+--
WITH PLLORDIN'dNCES AND LAWS REGULATING HEATING, VENtI- APPROVALS DATE INSPECTOq'S SIGNATVRE
LATING. AIR CONDITIONING.
ROUGH
HEREBY CERTIFY THAT AM NOT ACTING IN VIOLATION
OF CX9. DIVISION OF THE BUSINESS AND PROFESSIONAL FINAL
OF THE
_7
CODE OF E DIVISION
OF CALL IFDq NI A.
SIGNATURE i PERMIT VALIDATION C, M.0. CASH
OF PERMITTEE
PLAN CHECK VALIDATION EK. M.D. CASH