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76A6�- cee1e - 3-69 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING �✓
DEPARTMENT OF COUNTY ENGINEER ADDRESS IZO
BUILDING AND SAFETY DIVISION
JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY
COLEMAN W.JENKINS,SUPERINTENDENT OF BUILDING NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
ABSORPTION SYSTEM, BTU CITY ` TEL. N0. Y41�kOA /
AIR HANDLING UNIT, CFM CONTRACTOR
ADDRESS /L• V '
BOILER, HORSEPOWER
CITY Al TEL. NO.
COMPRESSOR, HORSEPOWER 4)1> STATE LIC. y
LICENSE NO. I,� �o CLASS V
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PROCES,SEEDD�BY
EVAPORATIVE COOLER
FURNACE: FAU GRAVITY l C
FLOOR BTT-140- dJ MSPECTION R ORD
HEATER: SUSPENDED UNIT
WALL
CLO
U
ell
V
w
CL
NEW—ADDITION— PERMIT $ 3 00 Z
ALTER_REPAIR_ TOTAL FEE $ 2
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL. N0.
IHEREBY 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,VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING. oe
IHEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH
CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STATES CALIFORNIA.
SIGNATURE /�/����� JACK R. ALLEN, SUPER VIS G MECHANICAL ENG'R.
OF PERMITTEE
PERMIT VALIDATION CK, M.O. CASH
zPLAN CHECK VALIDATION
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE lr� V