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BA364-CEBIS-I-68 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
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COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER 7ADDRESS
BUILDING AND SAFETY DIVISION JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OFBUILDINGFOR APPLICANT TO FILL IN c_I Iy i C
(Print or type only)
OWNER
NO.. TYPEiOPAPPLIANCE OR EQUIPMENT FEE MAIL
ADDRESS Q•
-XBSORPTION SYSTEM, BTU CIT TEL. NO.:Z�
AIR HANDLING UNIT, CFM CONTRACT dh
BOILER, HORSEPOWER ADDRESS
/ COMPRESSOR, HORSEPOWER ,r CITY TEL. NO. j
STAT LIC.
VENTILATION SYSTEM LICENSE NO. CLASS C��O
DISTRICT NO. GROUP ZONE PR BY
EVAPORATIVE COOLER
FURNACE: FAU GRAVITY
I FLOOR-BTU % �Oc�G ��^ -r-cl 1 SPECTION RECORD
HEATER: SUSPENDED-UNIT-
WALL
USPENDED UNIT WALL
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a
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NEW—ADDITION— PERMIT $ 1 3 00
ALTER—REPAIR— TOTAL FEE g
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
HEATING, VENTILATING, AIR CONDITIONING. _
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL
CODE OF THE STATE OF CALIFORNIA. APPROVALS DATE SPECTO 'S IGNATURE
SIGNA T URE ROUGH
OF PERMITTEE
FI NAL
JACK R. ALLEN
Oml�ATION
. CASH SUPERVISING MECHANICAL ENG'R.
LA. o .2 3. 9% SEP 4 4 -: D .15.5. 0`" Q .
iEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE-