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APLICATION FOR ERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING .17
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY JA•
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE&SIZE OF EQUIPMENT FEE ADDRESS
SEE BACK OF APPLICATION
CITY TEL. NO.
FORCE AIR FURNACE, BTU
"
CONTRACTOR j
6
COMPRESSOR,'BTU
ADDRESS 2
VENTILATION FAN CITY TEL. NO. 7
LIST ALL OTHERS BELOW STATE LIC.
LICENSE NO. CLASS
' DISTRICT NO. GROUP bZONE SSED BY
3 TIO 00
INSPECTION RECORD
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Pian check fee. See reverse.
F'I':li�ll'I" ISS1;"1VG FEE S /
1'0"1'A1, FE
®U
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 ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING,.AIR CONDITIONING.
ROUGH �� �7
I HEREBY- CERTIFY THAT I AM NOT AC ING IN TION
OF CHAPTER 9, DIVISION bF H BUSINESS NO P FESS NAL FINAL
CODE OF THE STATE OF C LIFO N
.SIGNATURE ' 11
OF PERMITTEE PERMIT VALIDATION cK. M.O.` CASH.
OF PET
PLAN CHECK VALIDATIO K, M.O. C .
078iNOV 14 4,1 D1 0 ® �