HomeMy Public PortalAbout6025 HART AVE_Mechanical__ 11 % 02 l�`y
76 A36h'- C�BtB - 9-71
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
ADDRESS
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST. �As
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) ^`
MAIL
NO. TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRESS 0/10 - 1!.�[
te,7 ST
CITY GjT TEL. NO.
ABSORPTION UNIT, BTU
CONTRACTOR
i R ADDRESS
BOILER, BTU
CITY � T: TEL. NO. y�3—dOSy'
COMPRESSOR, BTU O �/ STATE LIC.
LICENSE NO. G 7 CLASS v
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PRo ED v
t�t T �
EVAPORATIVE COOLER V `JV d >..
FURNACE: FAU GRAVITY CD
FLOOR BTU INSPECTION RECORD
HEATER: SUSPENDED-UNIT-
WALL
USPENDED UNIT_WALL v
Lu
CL.
N
Z
Plan check fee 25% of above. See reverse.
PERN]IT ISSUING FEE $ s 00
TOTAL FEE 1310
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 DA E INS TOR'S SIGNATURE
LATING, AIR CONDITIONING.
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3 OF THE BUSINE AND PROFESSIONAL FINAL
CODE OF THE STATE OF C IFORNIA.
SIGNATURE
OF PERMITTEEPERMIT VALIDATION 9C1
.0. SHCA
PLAN CHECK ALI ATION CK. M.O. CASH
Ao 7e 4 3 .13 .AUG..1'0 4 1 D 1.3'.&0
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE