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m. APPL[CA ION FOR PERMI
HEATING - VENTILATING - A.IR CONDITIONING
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING /•A�
(PRINT OR TYPE ONL" ADDRESS C9
LOCALITY E.
NO. TYPE OF APPLIANQE OR EQUIPMENT FEE
NEAREST
CROSS ST.
ABSORPTION UNIT,BTU
OWNER M
/�
AIR HANDLING UNIT,CFM MA'L4C A, -/5 2LI3 6
BOILER,BTU
CITY TELNO.ZY2-
COMPRESSOR,BTU CONTRACTOR'
VENTILATION SYSTEM
ADDRESS -2-
EVAPORATIVE
EVAPORATIVE CO%-ER CITY TEL NO4jVr 1
FURNACE: FAU GRAVITY STATE LIC. .J�.-�
FLOOR BTU LICENSE NO. CLASS �J ,
HEATER: SUSPENDED UNfT_ ApMt0VAu DATE I?MPECTOR-5S4IUTu
WAI I
ROUGH
FINAL
INSPECTION RECORQ
O
Plan check fee 25% of above.
PERMIT ISSUIN FEE$ _
TOTAL FEE
PLAN HECKAPPLICANT PLAN CHECK VALIDATION,
NAME
Al)DRE8
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
bRDINANCES AND LAWSREGULATING HEATING. VENTILATING, AIR
coNDmoNINc. PERMIT VALIDATION
I HEREBY CERTIFY THAT I AM -NOT ACTING IN'VIOLATION OF
CHAPTER O, DIVISION 3, OF-THE BUSINESS AND PROFESSIONAL CODE ;90463A
OF THE STATE OF CALIFORNIA.
SIGNATURE
OF PERMrr-MF # O„O 0 0 4 9
D LST'RICT wo. ... . . .•'21- o27,00
2 7,0-0 5
5-.78
L
1--4 (C;x-a1w 111-76 APPLICATION FOR PERMIT
y r HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES
_ DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUI
ADDRESS
(PRINT OR TYPE ONLY)
LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST
IlkCROSS ST.
ABSORPTION UNIT,BTU
OWNER '
AIR HANDLING UNIT,CFM MAIL _
ADDRESS
BOILER,BTU CITY EL NO.
COMPRESSOR,BTU CONTRACTOR
VENTILATION SYSTEM ADDRESS L./ �--� `
EVAPORATIVE COOLER CITY L NO. /�
FURNACE: FAU_GRAVITY STATE �� LIC.'
FLOOR BTU LICENSE NO. C
HEATER: SUSPENDED UNIT- DLSTRICT P(O. GROUP zo B)9Y
WA1 1
INSPECTION RECORD O
V
OL
O
Plan check fee 25% of above. i
PERM ISSUING FEE$ - -
TOTAL FEE
LRE'Y
HECK APPLICANT
SS
my TEL NO. -
EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCATION AND
THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL _
NCES AND LAWS REGULATING HEATING, VENTILATING, AIRIONING.HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF APPROVAu -�-�% � J�Atr ���� MSPE R'S SIGNATURE
ER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL CODE ROUGH STATE OF CALIF NIATUREFINALRMn- �`~
PLAN CHEC ALIDATION cx �.o. w1+
PERMIT VALIDATION ck 1-o. cAsa
1 9 2'r--tet+ 24 4 1 9 1 2.0 0