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APPLICATION FOR PERMIT e
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES ADORDESS ago
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY G
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING f Il
CROSS ST. Ilk,e-m
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO. TYPEOF APPLIANCE OR EQUIPMENT FEEADDRESS
CITY TEL NO. �- �ys'
ABSORPTION SYSTEM, BTU
CONTRACTOR }
AIR HANDLING UNIT, CFM i;'6
ADDRE ?- `
BOILER, HORSEPOWER CITY TEL. NO. y Z/
O� O
COMPRESSOR, HORSEPOWER STATE LIC.
LICENSE NO. CLASS-'3G' L
VENTILATION SYSTEM DISTRICT NO. CLASS GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER r D
3
FURNACE: FAU — GRA,.VITY
FLOOR BTU 0!65 IN PECTION RECORD
HEATER: SUSPENDED—UNIT—
WALL
USPENDED_UNIT WALL
r
D_
0
U
O
F-
U
H
NEW—ADDITION— PERMIT S 3 00 Z
ALTER—REPAIR— TOTAL FEE $ /
PLAN CHECK APPLICANT /
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLE0 GE 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.
ROUGH
1 XEREBT CERTIFY THAT 1 AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF THE BU NESS AND PROFESSIONAL FINAL �' rp G
CODE OF THE STATE OF CALI RNIA. `
SIGNATURE h, JACK R. ALLEN,SUPERVISING MECHANICAL ENG-R.
OF PERMITTEE GW
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION
! 7758N 14DV2441 D 11.00 - Q
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE