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�APPL N FOR P IT
HEATING - VENTILATING.- AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS. s�
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE'ONLY)
MAIL -
NO TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRESS
CITY TEL. NO.
ABSORPTION UNIT, BTU
CONTRACTOR
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU �y
q/ CITY TEL.'NO. S Y
COMPRESSOR, BTU STATIf LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE ;2ESSED BY
EVAPORATIVE COOLER
FURNACE: FAU GAVI®Y�_
FLOOR BTU INSPECTION RECORD
HEATER: SUSPENDED UNIT_ stf VY1L� f//V!T TC> 7-/�'ZIYI
WALL
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Plan check fee 25% of above. See reverse, z
PERMIT ISSUING FEE 8
TOTAL FEE
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, VENT]- APPROVALS DATE MSPECTOR'S'SIGNATURE
LATING, AIR CONDITIONING
ROUGH .. �
I 'HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF THE BUSI SS AND PROFESSIONAL FINAL �•6 ///'�Y{er��..^�
CODE OF THE STATE AL FOR NIA.
SIGNATURE PERMIT VALIDATION K. M.O. - CASH
OF PERMITTEE
PLAN CHECK VALIDATION CK. M.O. CASH
0 4 r"'MAY 5 4 1 D 1 9.� �
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