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76A360 - CEBIR - 3-69 APPLICATION FOR PERMIT
~ . HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION (d
JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY
COLEMAN W.JENKINS,SUPERINTENDENT OF BUILDING NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER ^ -
(PRINT OR TYPE ONLY) -
MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS e
ABSORPTION SYSTEM, BTU CITY TEL. N0.
Z
CONTRACTOR
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, HORSEPOWER
CITY TEL. NO.
COMPRESSOR, HORSEPOWER STATE LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT N0. GROUP �ZONEZSEO Br
EVAPORATIVE COOLER
FURNACE: FAU GRAVITY
FLOOR BTU INSPECTION RECORD
HEATER: SUSPENDED—UNIT—
WALL
USPENDED_UNIT_WALL
}
O
V
w
O
H-
U
ELI
NEW—ADDITION— PERMIT $ 3 00 Z
ALTER_REPAIR_ TOTAL FEE $
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 DATE INSPECTOR'S SIG E
LATINS, AIR CONDITIONING.
HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH
CHAPTER 9, DIVISIDN 3, OF THE BUSINESS AND P OFESSIONAL FINAL
CODE OF THE STATE.OF ALIFORNIA. O
SIGNATUREJACK R. ALLEN, 5 ERVI MECHANICAL EN +
OF PERMITTEE PERMIT VALIDATION CK.
M.O. CASH
' PLAN CHECK VALIDATION
if AO 2 6 8Ez! JM 8 Q 1 D 7.0 0
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE