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76A369-CE I6 3-69 APPLICATION FOR PERMIT V
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES FAODRESS
112 Z -
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
JOHN A. LAM BIE, COUNTY ENGINEER
COLEMAN W.JENKINS, SUPERINTENDENT OF BUILDING
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FOR APPLICANT TO FILL IN e'
(PRINT OR TYPE ONLY)
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
ABSORPTION SYSTEM, BTU CITY TEL. NO. 7,
CONTRACTOR
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, HORSEPOWER
CITY TEL. NO.
COMPRESSOR, HORSEPOWER STATE ! LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER
FURNACE: FAU GRAVITY ,\ ✓✓ \\
FLOOR BTU INSPECTION RECORD
HEATER: SUSPENDED
WALL / }
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NEW_ADDITION PERMIT S 3 00 Z
ALTER_REPAIR_ TOTAL FEE $
PLAN CHECK APPLICANT
NAME
ADDRESS S f
CITY TEL NO.
1 HEREBY ACKNOWLEDGE THAT NAVE READ THIS APPLICATION
AN STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING,VENTI- APPROVALS TE PECTO 'S IGNATUftE
LATING, AIR CONDITIONING.
HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH
CHAPTER 9, DIVISION OF THE BUS INES ANO PROFESSIONAL FINAL
CODE OF THE STATE 0 C LIFORN IA. 7^'^7� H. >i1 ✓kY
SIGNATURE JACK R. ALLEN, SUPERVI NG.MECHANICAL ENG-R.
OF PERMITTEE
PERMIT VALIDATION cK. ,J M.O. CASH
PLAN CHECK VALIDA ON
I.Ar.5104ti 14AY26 41 D 7.00y r
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE /��C/✓✓'V