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APP ATION F ERMIT
HEATING - 1!E ILATIHG - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS �eJ
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN. OWNER
(PRINT OR TYPE ONLY) • �� . -
• MAIL /�
NO. TYPEOFAPPLIANCEOR EQUIPMENT FEE ADDRESS S �� 4
CIT TEL NO. a,q7��0a
ABSORPTION UNIT, BTU
CONTRACTOR ��
AIR HANDLING UNIT, CFM C4J
ADDRESS
BOILER, BTU CITY TEL. NO.
COMPRESSOR, BTU STATE LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE CESSED BY
.�
EVAPORATIVE COOLER �j
FURMACE: FAUGRAVITY C/
FLOOR BTU INSPECTION RECORD
HEATER: SUSPENDED-UNIT-
WALL
USPENDED UNIT_WALL C/
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Plan check fee 25% of above. See reverse. z
PERi191T ISSUING FEL: S 3 00
TOTAL FEE . �.
PLAN .CHECK APPLICANT
NAME
ADDRESS ®�p
CIT CI& TEL.NOZO-3/Z
I HEREBY ACKNOWLEDGE THAT F HAVE 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
LATING, A I R.CONDITIONING.
ROUGH 'd,
I HEREBY CERTIFY T I AM NOT CTI G IN VIOLATION
OF CHAPTER 9, DIVISION THE SI S D PROFESSIONAL FINAL �1 �,
CODE OF THE STATE OF I NIA. T
-SIGNATURE PERMIT VALIDATION CK. M.O. CASH
OF PERMITTE
PLAN CHECK VALIDATION CK. M.O. CASH
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE