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76 A364 - CE 818-1/75
APPLICATION FOR PERMIT
HEATING - VENTILATING -.AIR CONDITIONING
COUNTY OF LOS ANGEtES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS dbl&mt + Lot #17
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN
DOWNER �
(PRINT OR TYPE ONLY) �7 -nd
MAIL
TYPE&SIZE OF EQUIPMENT ADDRESST
NO. SEE BACK OF APPLICATION FEE .L ,T 0 ll' nn
FORCE AIR FURNACE, BTU ^ a{� CITYi1 TEL. NO.
COMPRESSOR, BTU ;! t. (
CONTRACTOR � 4h I� !It>e 1'*
T ADDRESS ! ;x*X4ren
I VENTILATION FAN CI T Y ' ^ J f+l�f TEL. NO. 137..67
LIST ALL OTHERS BELOW STATE LIC.
LICENSE NO. 2 CLASS r�20
^ISTRICT NO. I GROUP ZONE PROCESSED 01'
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INSPECTION RECORD 0
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Plan check fee. See reverse.
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PLAN CHECK APPLICANT
NAME
A DDRESS
CITY TEL.NO.
I HEREBY AkRNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING. AIR CONDITIONING.
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OAl
F CHAPTER 9. DIVISfON 3, OF THE BUSINESS AND PROFESSIONAL FINAL i
CODE OF THE STATE OF CALIFORNIA.
SIGNATURE PERMIT VALIDATI N CK. v..U.OF PERMITTEE
PLAN CHECK VALIDATION CK. d M'o. CASH