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76A364-CE818-1 68 - APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONOITI NING
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
COLEMAN IN JENKINS SUPERINTENDENT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
(Print or type only)
OWNER
No TYPE,OFAPPLIANCE OR EQUIPMENT FEE
MAIL
ADDRESS
ABSORPTION SYSTEM BTU CITY �iM ! TEL NO
AIR HANDLING UNIT CFM CONTRACTOR �'L" 02 tiC
BOILER HORSEPOWER ADDRESS 70 (� V
COMPRESSOR HORSEPOWER CITY TEL NO yp(y124CO
STATE LIC /
VENTILATION SYSTEM LICENSE NO O CLASS :3
DISTRICT NO GROUP ZONE P CESSED BY
EVAPORATIVE COOLER
FURNACE FAU GRAVITY >-
a
FLOOR—BTU I INSPECTION RECORD v
HEATER SUSPENDED UNIT G
WALL p p
F—
U
W
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f/J
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NEW—ADDITION— PERMIT $ 3 00
ALTER—REPAIR— TOTAL FEE $ d�;
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
HEATING VENTILATING AIR CONDITIONING
IHEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9 DIVISION 3 OF THE BUSINESS AND PROFESSIONAL
CODE OF THE STATEOF IFORNIA / APPROVALS DAT I SP TORS SIGNATURE
SIGNATURE ( ROUGH I
OF PERMITTE C�
FINAL
7OVA IDATION JACK R ALLEN
CK M
CASH SUPERVISING MECHANICAL ENG R
LACC) 6 7 4 3'1-0' &L T g 4 1 D 7 0 0
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE 1,90�
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