HomeMy Public PortalAbout5417 GOLDEN WEST AVE_Mechanical__ 7SA364E fC*E-B1BA)-9/77 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
lity of 'Tcl lel -aty
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIOI-,`
FOR APPLICANT TO FILL IN BUILDING 77 armq B,.# r.�♦ �c),
(PRINT OR TYPE ONLY) ADDRESS ,L. Golden .4vj T,*t *,4
LOCALITY ,ample �Ity
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
L CROSS ST.
ABSORPTION UNIT,BTU
OWNER GeO :�...
AIR HANDLING UNIT,CFM MAIL
ADDRESS If .5 31 .3'3ke !Ane
BOILER,BTU CITY d�i TEL.NO.
1 COMPRESSOR. BTU 4,3,ox 10 w CONTRACTOF&I:3 +,�w.�. �y
.
VENTILATION SYSTEM ADDRESS r ^' n
EVAPORATIVE COOLER CITY .�y y TEL.NO. 3 73
FURNACE: EAU_G1�hTY _ i.^6 ns1 STATE ,. LIG.
FLOOR BTU .. + 0 "0 LICENSE NO. ,757_ CLASS CI""::'-
HEATER: SUSPENDED UNIT- DISTRICT NO. GROUP ZONE PROCESSED BY
WALL
O
INSPECTION RECORD V
U.J
Plan check fee 25% of above. Q�
PERMIT ISSUING FEE O
a
TOTAL FEE 57100 Lu
r-
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING HEATING, VENTILATING, AIR
CONDITIONING.
IHEREBY CERTIFY THAT I AM NOT ACTING IN.VIOLATION OF APPROVALS DATE INSPECTOR'S SIGNATURE
CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL CODE
OF THE STATE OF CALIFORNIA. ROUGH
SIGNATURE
OF PERMITTEE ....y. FINAL
PERMIT VALIDATION CK M O. cns
PLAN CHECK VALIDATION CK M.O. 'ZOASHa
I r o
�s