HomeMy Public PortalAbout5604 HALLOWELL AVE_Mechanical__ 76 A364 - CE 818-1/75
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING l'
DEPARTMENT OF COUNTY ENGINEER ADDRESS d'7 6
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
N0. TYPE&SIZE OF EQUIPMENT FEE ADDRESS f}JC
SEE BACK OF APPLICATION
CITYC �. TEL. NO.
FORCE AIR FURNACE, BTU
44"/��12�
COMPRESSOR, BTU CONTRACTOR vv 0
ADDRESS SRN
VENTILATION FAN CITY TEL. NO.
LIST ALL OTHERS BELOW STATE LIC.
.y) LICENSE NO. CLASS
y DIST R ICT N0. GROUP ONE P CESS EO BY
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INSPECTION RECORD
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Plan check fee. See reverse. z
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, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING.
I HEREBY CERTIFY THAT 1 AM NOT ACTING IN VIOLATION ROUGH .L 1�.-.f,�s /
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL
-71:--�
CODE OF THE STATE OFICCAA.IFORNIA.�j;�� �
SIGNATURE /' --cl'�� n� QQ PERMIT VALIDATION CK � M.O. CASH
OF PERMITTEE. L!(O�A'�''�'
PLAN CHECK VALIDATION CK. M.O. CASH
1 1 4 --rFR 10 4 1 0 9.0 0 A ci
76A364
CE-j18 (REV.11/78)
os APPLIC TION FOR PE IT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDINGAf ND SAFETY
FOR APPLICANT TO FILL IN BUILDING j
(PRINT OR TYPE ONLY) ADDRESS
LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE �7
NEAREST
CROSS S
ABSORPTION UNIT,BTU � )
OWNER
AIR HANDLING UNIT,CFM MAIL
ADDRESS
BOILER,BTU Jx CITY �� � ! TEL.NO.Il.�� �
COMPRESSOR,BTU '� / �/ CONTRACTOR / J
VENTILATION SYSTEM
ADDRESS
EVAPORATIVE COOLER. CITY TEL.NO.
FURNACE: FAU GR VITY STATE LIC.
FLOOR BTU LICENSE NO. CLASS
HEATER: SUSPENDED UNIT_ APPROVALS DATE INSPECT03S SIGNATURE
WALL p� �
ROUGH
FINAL ��, '� �
u u
INSPECTION RECORD 0
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Plan check fee 25% of above.
vt
PERMIT ISSUING FEE$
TOTAL FEE
PLAN CHECK APPLICANT PLAN CHECK VALIDATION
NAME �A�.�✓—'—"
✓ f,
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 26 34,7A
ORDINANCES AND LAWS REGULATING HEATING, VENTILATING, AIR
CONDITIONING. PERMIT VALIDATION # o'o o o 4 1
1HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF
CHAPTER 9. DIVISION 3. OF THE BUSINESS AND PROFESSIONAL CODE 0 o 37,00'�O O
OF THE STATE OF CALIF ]A. 2
SIGNATURE O o o 3 7 O O V
OF PERMITTEE
DISTRICT NO. �P�R�O��,�/5�/g/Y 0 O•p 7—r7 n
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