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APPLICATION FOR OiRMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY
, NEAREST
CROSS S
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) Lv
MAIL
NO TYPE OF APPLIANCE OR EQUIPMENT FEE NO ��ve ast
ABSORPTION UNIT, BTU CITY TEL. NO.
CONTRACTOR C
AIR HANDLING UNIT, CFM
ADDRESS el
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BOILER, BTU CITY TEL. NO
COMPRESSOR, BTU O STATE p d L C
LICENSE NO. e7,70 �O-ow'1 CLASS
VENTILATION SYSTEM DISTRICT NO GROUPv�ONE PROCESSED BY
EVAPORATIVE COOL,E Ri `
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/ FURNACE: FAU GRA TY
FLOOR BTU O� a(J INSPECTION RECORD
HEATER: SUSPENDED UNIT_
WALL
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Plan check fee 25% of above. See reverse. z
PEWN11T ISSUING FEE S 3 00
TOTAL FEE O
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALLORDINANCES AND LAWS REGULATING HEATING, VENTI- _ APPROVALS DATE INSPECTOR'S SIGNATURE
LAT ING, AIR CONDITIONING
ROUGH
I HEREBY CERTIFY TH T I AM NOT ACTING IN VIOLATION OF CHAPTER 9, DIVISIO THE BUSI AND ROFE�,SIONA FINAL Ew
CODE OF THE STATE CALIF RNf
SIGNATURE 1 0 0
PERMIT VALIDATION (Cy M O CASH
OF PERMITTEE
PLAN CHECK ALIDATION' CK o cnsH p" ,�
2 1 4 idL 25 4,1 D 1 3.0 0 ✓`
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE