HomeMy Public PortalAbout6463 LIVIA AVE_Mechanical__ 76A3%.;E ICJrr,2'&A'"9/77 APPLICATION FOR PERMT,
HEATIN - VENTILATING - AIR CONDITIONING
COU ANGELES
DEPARTMENT OF COUNTY EN EER
BUILDING AND SAFETY DIV ION
FOR APPLICANT TO FILL IN BUILDING
ADDRESS
(PRINT OR TYPE ONLY) /�J
LOCALITY
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROS T
ABSORPTION UNIT,BTU
OWN IL
AIR HANDLING UNIT,CFM MAIL
AA—
ADDRESS
BOILER,BTU CITY TEL NC&1e
COMPRESSOR, BTU CONTRACTOR O
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CITY TEL NO
FURNACE FAU GRAVITY STATE LIC
FLOOR BTU LICENSE NO CLASS
HEA R SUSPENDED UNIT- DISTRICT NoouP JJEULPRCESSED By
WALL /
INSPECTION RECORD
O
O
Plan check fee 25% of above
PERMIT ISSUING FEE$ , Z
TOTAL FEE
PLAN C E APPLICANT
NAME
ADDRESS
CITY TEL NO
I HEREBY ACKNOWLEDGE THAT I HAVE READ IS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING HEATING, VENTILATING, AIR
CONDITIONING
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF APPROV is
DATE R'S SIGNATURE
CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL CODE
OF THE STAT �CAORNIA ROUGH
SIGNATURE FINAL -/ l
OF ERIVIITTE=='�!, zs.� 7:��1.
PLAN CHECK VALIDATION cK Mo CASH PERMIT VALIDATION CK Mo CASH
3-4 5 ro-)JUL 3 4-J D 2 7.0 0
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