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APPLICATION FOR PERMIT
HEATING'- VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND' SAFETY DIVISION LOCALITY- Lr
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OW NER1 pp
(PRINT OR TYPE ONLY)
'MAIL
NO:. TYPE&SIZE OF EQUIPMENT ''j FEE ADDRESS zvN -Ycr
SEE BACK OF APPLICATION
CITY / TEL. NO.
FORCE AIR FURNACE, BTU
CONTRACTOR
COMPRESSOR, BTU
ADDRESS
VENTILATION FAN '
CITY TEL. NO.
LIST ALL OTHERS BELOW STATE LIC.
LICENSE NO. CLASS
Me". DISTRICT NO. GROUP ZONE PROCESSED BY
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INSPECTION RECORD
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Plan'check fee. See reverse..
PICH)'ll"F I SIJLV`G FFF; 3
1,0T.M, 1',E fZc7O
PLAN CHECK APPLICANT '
NAME
ADDRESS -
CITY TEL.NO.
"I HEREBY ACKNOWLEDGE THAT.1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREETO COMPLY- -
q WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING: AIR CONDITIONING. -
ROUGH
I- HEREBY CERTIFY THAT I AM NOT ACTING ..IN VIOLATION /
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND"PROFESSIONAL FINAL �Z,i v✓ 'K
CODE OF THE STATE OF ALIFOR NI _
SIGNATURE 1 PERMIT VALID*T, cK. M.O. CASH
OF PERMITTEE
PLAN CHECK VALIDATION CK. M.0. CASH
so D.CAN X 1 4 1 1 2.C� l7 e