HomeMy Public PortalAbout5211 HALLOWELL AVE_Mechanical__ •'76 A364- CE 818-1/75 "
•A'P,PLI:CA-TION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT•OF COUNTY•ENGI'NEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY �L �F
NEARESTCROSS ST.
FOR,APPLICANT TO FILL IN OWNER'
•yl' (PRINT OR TYPE ONLY)
MAIL
NOP •TYPE.&SIZE OF,EQUIPMENT FEE -ADDRESS
P /y :' "• ' '
SEE'BACK OF APLICATION - -- - t � �n� -
CITY TEL.NO•��'j4V
`
FORCE'AIR FURNACE, BTU
CONTRACTOR
COMPRESSOR, BTU
ADDRESS O
VENTILATION FAN ,
CITYX• �� _ EL. NO
17
LIST ALL OT RS BELOW STATE /f LIC: v '
LICENSE NO. OJ CLASS
DISTRICT N0. GROUP ZONE P CESSED,BY
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INSPECTION RECORD • '
IL
O
H
N
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Plan check fee. See.reverse.
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' -roe°�al,:)''rr;' . ' ' • . '. '
PLAN CHECK, APPLICA',NT
NAME
ADDRESS '
CITY TEL NO, -
•I HEREBY, ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION t .
AND STATE THAT THE ABOVE IS•CORRECT'ANO AGREE TO COMPLY _
WITHALL ORDINANCES' AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSP,ECTOR'S SIGNATURE _
LATI NG, AIR CONDITIONING -
ROUGH
I HEREBY CERTIFY THAT 1 AM ,NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3„6F THE BUSINE S AND'PROFESSIONAL FIN A L`- 7G '
CODE OF THE STATE, C UFOR A
SIGNATURE PERMIT ,VALIDATION cK. M.0. - CASH
OF PERM I_TTEE
PLAN 'CHECK. VALIDATION CK. M.O.. CASH
0,7 31,,sEp. 3' 4 ,i --D
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