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76�q64 - CE819 - 3-69 APPLICATION FOR PERMIT
r HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER' ADDRESS �D��/ A S
BUILDING AND SAFETY DIVISION T/ y�/ n y
JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY / C�/!t-
COLEMAN W.JENKINS,SUPERINTENDENT OF BUILDING NEAREST A
CROSS ST. bK / �fIQnI
FOR APPLICANT TO FILL IN OWNER ,rl!_,c GrQ '� -TZ
(PRINT OR TYPE ONLY)
MAIL /J
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS f0 / If /L/�
ABSORPTION SYSTEM, BTU CITY /E.ZfPL�G. Ci/T1' TEL. NO. "! VIV 3J�
AIR HANDLING UNIT, CFM CONTRACTOR
ADDRESS
BOILER, HORSEPOWER
CITY TEL. NO.
COMPRESSOR, HORSEPOWER
4, OCDSTATE LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PRO BSED BY
EVAPORATIVE COOLER 1
FURNACE: FAU GRAVITY_
FLOOR BTU INSPECTION RECORD
HEATER: SUSPENDED-UNIT-
WALL
USPENDED_UNIT_WALL }
a
0
U
s
0
1-
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NEW_ADDITION_ PERMIT $ 3 00 ?
ALTER--REPAIR— TOTAL FEE S IZ
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL. NO.
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING,VENTI- APPROVALS D E I ECTOR'S SIGNATURE
LATING, AIR CONDITIONING. IY
I HEREBY CERTIFY THAT I AM NOT ING IN VIOLATION OF ROUGH
CHAPTER 9, DIVISION 3, OF THE BU E AND PROFESSIONAL FINAL
CODE OF THE STATE OF CALIF RNIA.
SIGNATURE JACK R. ALL N SUPERVIS ECHANICAL ENG-R.
OF PERMITTE
PERMIT VALID ON CK. M.O. CASH
PLAN CHECK VALI TIO
uto ° n NN 2041 D 12.00-- v
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE