HomeMy Public PortalAbout5104 FARAGO AVE_Mechanical__ 76 A36j CE 818 1/75
r" APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
5
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 ONLY) at
MAIL /
NO TYPE&SIZE OF EQUIPMENT FEE ADDRESS
SEE BACK OF APPLICATION
FORCE AIR FURNACE BTU A60 CITY /r TEL NO ,
CONTRACTOR
COMPRESSOR BTU A /
ADDRESS /v
VENTILATION FAN CITY TEL NO
LIST ALL OTHERS BELOW STATE LIC
LICENSE NO CLASS
DISTRICT NO CROUP ZONE PROC 5 ED BY
B �L Q 3 sc
INSPECTION RECO
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Plan check fee See reverse z
PI 1011 IS111 I\L F1 I S
101 11 I 1 1 / —.—
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY �`t C x TEL NOI,[ -3.>'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALLORDINANCES AND LAWS REGULATING HEATING VENTI APPROVALS DATE i INSPECTOR S SIGNATURE-
LATING AIR CONDITIONING
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9 DIVISION 3 OF THE BUSINESS AND PROFESSIONAL FINAL 2
CODE OF THE STATE OF CALIFORNIA r
SIGNATURE PERMIT VALIDAT N CK M 0 CASH
OF PERMITTEE
PLAN CHECK VALIDATION CK M O CASH
F
7 3 8�-,FEB 17 4 1 0 1200 �,�,�