HomeMy Public PortalAbout5217 GOLDEN WEST AVE_Mechanical__ 76 A364- CE 818- 5-73 - -
APPL TION FOR P MI'T
HEATING - VENTILATING - Al CONDITIONING
COUNTY OF LOS ANGELES BUILDING _
DEPARTMENT OF COUNTY ENGINEER ADDRESS '
BUILDING AND SAFETY DIVISION LOCALITY ' 44
NEAR EST
CROSS ST. =N.{
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) -
MAIL .
NO TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRJESS,5 21
CITY TEL. NO. '
ABSORPTION UNIT, BTU
CONTRACTOR
AIR HANDLING UNIT, CFM
ADDRESS5(,?;�_ '
BOILER, BTU CITY �( �iTEL. NO
COMPRESSOR, BTU STATELIC
LICENSE NO. _ u C ASSIC ( 4
VENTILATION SYSTEM DISTRICT No GROUP ZONE CESS ED BY
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EVAPORATIVE COOLER \
FURNACE: FAUGRAVITY 'INSPECTION RECORD
FLOOR, BTU
HEATER:- SUSPEN ED UNIT_ Z)
WALL (/
• d
0
• v
rx
0
W
- lh
Plan check fee 25% of above See reverse.
PERMIT ISSUING FEE $ 3 00
TOTAL FEE
PLAN CHECK APPLICANT
NAME,
ADDRESS
CITY TEL NO
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
'AND STATE THAT THE ABOVE IS CORRECT AND,AGREETO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS E SPECTO 'S TU
LATING, AIR CONDITIONING
ROUGH
I 'HEREBY CERTIFY THAT21 AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 341F HE BUSINESS D PROFESSIONAL FINAL
CODE OF THE STATE 0 F
SIGNATURE ��_ PERMIT VALIDATIO CASH
OF PERMITTEE •-
PLAN CHECK VALIDATION V M 0. CASH
4 AU6•• 2.4 1'',0 8.0 &AS6
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
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