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AF
PLICATlO FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS5SZ L01
BUILDING AND SAFETY DIVISION LOCALITY cGL�
NEAREST
CROSS ST. �.
FOR APPLICANT TO FILL IN OWNER r.nyA/ 77�� Co
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(PRINT OR TYPE ONLY) " I C/C..L�
N0, TYPE&SIZE OF EQUIPMENT FE MAIL Q > LL.
� ADDRESS
SEE BACK OF APPLICATION
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CITY�� /n-, TEL. NO. t
FORCE AIR FURNACE, BTU LtgI OD /
�7 CONTRACTOR
( COMPRESSOR, BTU �a t b0 � �J
ADDRESS • l Sb ow,
VENTILATION FAN \
CITY �7 ® 1 TEL. NO. �rZ(
LIST ALL OTHERS BELOW STATE
LICENSE NO. [ � [� CLASS (
DISTRICT NO, GROUP- ZONE. OCE SS ED BY
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INSPECTION RECORD
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Plan check fee. See reverse. z
PI 1011T LSSITIN(, FF'E S
"I'0"1'r11,
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY 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, VEN?I- 'APPROVALS DATE INSPECTOR'S SIGNATURE
LAT ING, AIR CONDITIONING. -
ROUGH � ,1
I HEREBY CERTIFY THAT I A OT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION F TI SI SS :AND PROFESSIONAL FINAL 1'2y-'76'
CODE OF THE STAT C LI RNI
SIGNATURE
PERMIT VALIDATION CK. M.O. CASH
OF PERMITTEE
PLAN CHECK VALIDA ON D M.O. CASH
1 1 2 3.2 5 AL-i;;
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