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76A364-c E818-�1-68 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING � "
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY `
NEAREST
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
(Print or type only)
OWNER
FEE
No. TYPE OF APPLIANCE OR EQUIPMENT MAIL
ADDRESS
ABSORPTION SYSTEM, BTU CITY TEL. NO.
AIR HANDLING UNIT, CFM CONTRACTOR-
_ r,
BOILER, HORSEPOWER ADDRESS,
rY v� CITY TEL. NO. �
P
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COM RESSOR, HORSEPOWERS -- � � �
STAT'�m LIC
VENTILATION SYSTEM ` LICENSE NO. �.�� I( .7 t CLASS
DISTRICT NO. GROUP ZONE P CESSED BY
EVAPORATIVE COOLER
FURNACE: FAU GRAVITY >-
a
FLOOR—BTU INSPECTION RECORD
HEATER: SUSPENDED UNIT
WALL O
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to
NEW—ADDITION— PERMIT $ 3 00 G
ALTER—REPAIR— TOTAL FEE $ 7 Lt` rl
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION --'(.:l
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 r
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL evv --
CODE OF THE STATE OF CALIFORNIA. APPROVALS DATE INS CTOR'S SIGNATURE
SIGNATURE , / '., ROUGH
OF PERMITTEE t. I _ S,, r
FINAL 10 (y
IDATI JACK R. ALLEN
CK./M.O. CASH SUPERVISING MECHANICAL ENG'R.
Lr � u89 Au"23- 4 1 D 7.0 0
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE %i1