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APPLIC N FOR PERMIT'-
kEATING -•► IENTILATING - AIR_CONO11•'IONIN'G
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COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS -
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST..
FOR APPLICANT TO FILL IN. OWNER
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MAIL ,
,NO TYPE&SIZE OF EQUIPMENT FEE ADDRESS -
SEE BACK OF APPLICATION - .. _ - - • . -- -
CITY TEL:.
7 FORCE AIR FURNACE, BTUY_ _
CONTRACTOR G'
COMPRESSOR, BTU
ADDRESS
VENTILATION FAN CITY �� TEL. NO.
LIST ALL OTHERS BELOW' STATE - LIC.
LICENSE NO. CLASS V
-DISTRICT NO. GROUP •ZONE CESS ED BY
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INSPECTION RECORD "
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Plan check fee. See reverse. z,
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PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO... '
I HEREBY'ACKNOWLED•GE THAT I.HAVEAEAD THIS APPLICATION
AND STATE.,THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH, ALL ORDINANCES AND LAWS REGULAT ING'HEAT.ING,'- VENTI- APPROVALS DATE INSPECTOR'5,SIGNATURE
LAT ING. AIR CONDITIONING _
a„r ROUGHT
I HEREBY CERTIFY THAT' I AM NOT ACTING 'IN VIOLATION ,
OF CHAPTER,9, DIVISION 3, THE.BUSINESS AND PROFESSIONAL FINAL -26'7
CODE OF THE STATE ,FOR NIA. I.
S1'GNATURE = ,PERMIT VALIDATION LL cK.-, M.0. +1-,
OF PERMITTE - \-
PLAN CHECK VALIDATION CK. M.0. CASH
7 '31,41-FEB 22.41 'D 1 2D Q
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