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APPLIOATIO9 FOR IPERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDINGa v l
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING CROSS ST.
W
FOR APPLICANT TO FILL IN
OWNER
' (PRINT OR TYPE ONLY) J b
MAIL
NO. TYPE OFAPPLIANCE,OR EQUIPMENT FEE
ADDRESS
CITY-
ABSORPTION
TEL. NO.
ABSORPTION SYSTEM, BTU
CONTRA CTO
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, HORSEPOWER CITY ffe EL. NO. OX
COMPRESSOR, HORSEPOWER STATE CENSE NO. / ?2 CLASS
VENTILATION SYSTEM DISTRICT N0. CLASS GROUP ZQONE/ PROCESSED BY
,/
EVAPORATIVE COOLER
FURNACE: FAU_GRAVITY
FLOOR BTU INSPECTION RECORD.
HEATER: .SUSPENDED UNIT_
.WALL
a
L. U C3
-360 .
U
NEW -ADDITIONPERMIT' $ 3 00 a
cn
y Z_
ALTER-REPAIR- TOTAL. FEE $
PLAN CHECK APPLICANT (G/
NAME
ADDRESS
CITY• TEL.NO.
I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALLORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LAT I NG,AIR CONDITIONING.
1 HE CERTIFY THAT I AM NOT ACTING IN VIOLATION ROUGH
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STATE CALIFORNIA.
SIGNATURE ( ,(� T�, JACK R: ALLEN,SUPERVISIN CHANICAL ENG'R.
OF PERMITTEE`�>• � ^�
PERMIT VALIDATION CK. M.0. CASH
PLAN CHECK VALIDATION
.00-Sl ('� 7 1`6 99 OCT 14 4'1 O 6.00-
SEE
EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE