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APPLI TION FON IT:
HEATING. - VENTILATING - Al' G®N®Il'IONIIdG .
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF.COUNTY ENGINEER ' ADDRESS
BUILDING AND SAFETY DIVISION', LOCALITY J'
NEAREST
CROSS ST.
FOR APPLICANT TO FILL•IN OWNER .-
(PRI NT OR'TYPE ONLY),
MAIL
NO. TYPE&-SIZE OF EQUIPMENT FEE MAIL
SEE BACK OF APPLICATION _
FORCE AIR FURNACE, BTU
CONTRA
COMPRESSOR, BTU �.
ADDRE
VENTILATION FAN CI E . N
LIST ALL OTHERS BELOW ST TE J1 LIC.
LICENSE NO.' Gi CLASS
DISTRICT NO - GROUP jQONE UPSSED BY. -
I7��v INSPECTION RECORD
IL
O
0
U
W
cn
Plan check fee. See reverse. z
PI Ii111'I' ItiSI IVG FEE
i'OTAL FEE n
PLAN CHECK APPLICANT.
NAM.
ADOR r
CITY EL.N
I HEREBY 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. _
ROUGH.
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLA N
' OF CHAPTER 9, DIVISION'S, O THE BUSIN S D PROFES L FINAL
CODE OF THE STATE OF C NI '
SIGNATURE" - PERMIT VALIDAT:FON: cK .M:o. CASH. - '
OF PERMITTEE •• „
.PLAN CHECK VALIDATION K. M.0.' CASH-- ' +7r�-