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76A364C
CE 818(REV 11/78)
®+ APPLICATION F PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN [NEAREST
LDING c
(PRINT OR TYPE ONLY) RESS
ALITY
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
OSS ST
l ABSORPTION UNIT BTU
OWNER
AIR HANDLING UNIT CFM MAIL
ADDRESS
BOILER BTU CITY A TEL NO
COMPRESSOR BTU CONTRACTOR
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CITY TEL NO
FURNACE FAU GRAVITY STATE LIC
FLOOR BTU LICENSE NO CLA
HEATER SUASPENDED UNIT_ APPROVALS VTE I PE j SSIGNATURE
ROUGH �s
FINAL 6- - Q
u
INSPECTION RECORD �
Plan check fee 25%of above
N
PERMIT ISSUING FEL$_
TOTAL FEE
PLAN CHECK PLICANT PLAN CHECK VALIDATION
NAME
I
ADDRESS
CITY TE L
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 VENTILATING AIR
CONDITIONING PERMIT VALIDATION 260&7A
1 HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF
CHAPTER 9 OF THE STATE OF CION OF THE BUSINESS AND PROFESSIONAL CODE u 4 1
SIGNATURE M
OFPERMITTEE 29 - 13.00
DISTRICT NO !P2SED `1 ,` • • .
13 005
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