HomeMy Public PortalAbout10240 GREEN ST_Mechanical__ 78 AA4- CE 818-I/78 .
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY � Z�
NEAREST xA i y-�u ��/I�y �
CROSS ST. L/ rV
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE&SIZE OF EQUIPMENT FEE ADDRESS
IRE BACK OF APPLICATION �j,�
CITY/ /lig TEL. NO.
FORCE AIR FURNACE, BTU
CONTRACTOR �-
COMPRESSOR, BTU
ADDRESS
V_ ENT_I LATI.ON ANL _ CITY --,,-TEL-. NO. - - -
LIST ALL OtH ERS BELOW STATE ��. LIC.
LICENSE NO. CLASS_
DISTRICT NO. GROUP ZONE S D Y
5- d8
/4-/
INSPECTION RECORD
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Plan check fee. See reverse.
PF.IINIIT I.SSVING Fh:F: i
TOTAI, FEF,
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.N07T3 7G�
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONO
AND STATG THAT THE ABOVE IS CORRECT AND AGREE TO CMPLY
WITH ALL ORDINANCES AND LAWS RESULATINS HEATING, VENTI- APPROVALS DATE INSPSCTORS SIGNATURE
LATIM4, AIR CO-NDITIONING.
• RID UG H
I HEREBY CERTIFY THAT I A4 NOT ACTING IN VIOLATION
OF CHARTER D, DIVISION S, OF THE BUSINESS AND PROFESS IONAL FINALlk�
�141 CODE OF THE STATE LIFORNIA.
SIGNATURE PERMIT VALIDATION CK, M.O. ASH
OF PERMITTEE
PLAN CHECK VALIDATION CK. M.O. CASH
8.1 _64-1 0 1 2.0 0 AN