HomeMy Public PortalAbout5328 LOMA AVE_Mechanical__ 76A364EICE-�16A1.9/77 APPLICATIORI FOR PERMT
MEATI G AIR DITIOWIPIG
COU OF LOS AN,
DEPARTM OF COUNTY ENES EER'
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUILDING /76
S } Q
(PRINT OR-TYPE ONLY) ADDRESS
' LOCALITY .'
NO. TYPE OF APPLIANCE OR EQUIPMENT •.•FEE'
NEAREST
CROSS ST
ABSORPTION UNIT,BTU
• OWNER
AIR HANDLING UNIT,CFM MAIL
ADDRESS
BOILER,BTU CITY TEL NO. Q I
i
COMPRESSOR,BTU
CONTRACTOR
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CITY TEL.NO.
FURNACE FAU-GRAVITY STATE LIC
FLOOR ' BTU LICENSE NO. CLASS
HEATER- SUSPENDED UNIT- DISTRICT NO GROUP ZONE PRO ESSED Y
WALL
03 -�
I ION RECORD 9L
O
u
c
O
Pian check fee 25% of above.
PERMIT ISSUING FEE -
TOTAL FEE
PLAN CHECK AP ICANT -
NAME
ADDRESS
CITY TE NO. '
IHEREBY ACKNOWLEDGE THAT.1 HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITWALL ,
ORDINANCES AND LAWS 'REGULATING HEATING,' VENTILATING, AIR
CONDITIONING. -
I HEREBYCERTIFY THAT I 'AM NOT ACTING IN VIOLATION OF APPROVALS DATE INSPECTOR'S SIGNATURE
CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL'CODE
OF THE STATE OF CA RNIA ROUGH
SIGNATURE FINAL
OF PERM ITTE
PLAN CHECK VALIDATION'' CK. MO CASH- PERMIT VALIDATION, CK M.o CASH
1 ;J
2 8 AUG'.14 4}1 U a 21 '7-.0 0 A�'
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