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76A364t-CE818-1/70 APPLICATION FOR PERMIT
• - HEATING - VENTILATING - AIR CONDITIONING
' COUNTY OF LOS ANGELES BUILDING ^)E
DEPARTMENT OF COUNTY ENGINEER ADDRESS VC+�—
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS, SUPERINTENDENT OF BUILDING NEAREST ��
CROSS ST
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) I I '
MAIL L
NO TYPE OFAPPLIANCE OR EQUIPMENT FEE ADDRESS
ABSORPTION SYSTEM BTU CITY G� a TEL NO 9 , 6r/ `Llr�
CONTRACTOR b '�- (�C ft A(
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, HORSEPOWER CITY I/t TEL NO
COMPRESSOR HORSEPOWER STATE Ic
STATE
LICENSE NO CLASS
VENTILATION SYSTEM DISTRICT NO CLASS GROUP ZONE PROCESSED
EVAPORATIVE COOLER 40IF .8Y
FURNACE FAU_GR TY INSPECTION RECORD
FLOOR BTU �
HEATER SUSPENDED UNIT_
WALL
L a
0
dr
v
m
NEW—ADDITION— PERMIT $ 3 00 y
Z
ALTER—REPAIR— TOTAL FEE $fit 1
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 DA)PE INSPECTOR S SIGNATURE
LATING AIR CONDITIONING
ROUGH
I HEREBY CERTIFY THAT I OT CTING IN VIOLATION
OF CHAPTER 9 DIVISION 3 OF TH SIN AND PROFESSIONAL FINAL I
CODE OF THE STATE C LI NI
SIGNATURE JACK R ALLEN,SUPERVISOCK
CNANICAL ENG'R
OF PERMITTEE
–
PERMIT
PERMIT VALIDATIOM o CASH
PLAN CHECK VALIDATION
I Ar-9 7 4 7c APR 16 4 1 D 11.00-- c
r
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE