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APPL CATION FOR MIT
HEATING - VEN1ILATIN6'-,AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING J 1,
(PRINT OR TYPE QNLY) ADbRESS
. �OCALfII'
NO. TYPE OF APPLIANCE 0R EQUIPMENT FEE -
NEAREST
CROSS S7.
ABSOR ION UNIT,BTU ,
OWNER
AIR HANDLING UNff,CFM MAIL -
ADDRESS
BOILER,BTW ° CITY TEL NO:
COMPRESSOR,BTU a 92V CON7RAC70R
.VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CnY TEL.NO.
14
FURNACE: FAU VrrySTATE LIC. `
FLOOR BTU LICEN O. CLASS C2-100to
HEATER: SUSPEN D UNIT APPROVALS DATE INSPECTOR'S SIGNATDRE ,
W
ROUGH
FINAL 7171541 Z44/-"
INSPECTION RECORD {7
Plan check fee 25% of above:
PERMIT ISSUING FES .
TOTAL,FEE
PLAN CHECK APPLICANT PLAN CHECK VALIDATION
NAME
ADDRESS ..
CFry TEL NO.
IHEREBY ACKNOWLEDGE THAT a HAVE READ THIS APPUCATION,AND _ - 4 9 1 1 .A '
STATE THAT THE ABOVE IS CORRECT AND AGRFE.TO COMPLY WITH ALL
ORDINANCES AND LAVAS REGUL nNG HEATING, VENTUTING, AIR
CONDITIONING. PERMIT VALIDATION #.0 0•o ° 4 1
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIQLA-DON OF Z
CHAPTER G, DIVISION F THE BUSINESS AND PROFESSIONAL CODE - .2 ° ° 3 7, 0 0
OF THE STATE 0 C NIA. i- ° ° P3700. 6
SFGNATURE
OF PERM
DLSTRJ CT NO. p11�11 - -
0613-79
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