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APPLICATION FOR PERMIT.
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING / 601d4f Z2 ale--51'-
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDYNG AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) !�
N0. TYPE 8 SIZE OF EQUIPMENT FEE ADIDRESS 6
ERR BACK OP APP'LIC N
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FORCE AIR FURNACE, BTU CI v TEL.
CONTRACTO
COMPRESSOR, BTU
ADDRESS
VENTILATION FAN CIT 0� TEL. NO. .-
LIST ALL OTHERS BELOW STATff LIC. n�O
LICENSE NO. CLASS 6
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DISTRICT HGROIJ I IONE [
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Plan check fee. See reverse.
PF,10111' ISSUING FEE S
1 TOTAL FEE.
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION
AND STAT[ THAT THE ABOVE Ib CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCESAND LAWS REGULATING HEATING, VENTI- APPROVALS DATE WSPECTORS SIGNATURE
LATIN$, AIR CONDITIONING.
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER D, DIVE S, OF THE 6 NESE AND PROFESSIONAL FINAL
CODE OF THE STAT F AL FOR NI A.
SIGNATURE PERMIT VALIDATION CK. M.0. CASH
OF PERMITT
4 bWEMNENNMI�-
PLAN CHECK VALIDATION CK. M.O. CASH
3 1 d-r HAY 16 41 0 19.5 0 e�