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APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING O
DEPARTMENT OF COUNTY ENGINEER ADDRESS7TE
BUILDING AND SAFETY DIVISION LOCALITYCRO ESTFOR APPLICANT TO FILL IN OWNER(PRINT OR TYPE ONLY) MAIL
NO TYPEOFAPPLIANCEOR EQUIPMENT FEE ADDRESS
CITY I NOABSORPTION UNIT BTU
CONTRACTOR pAIR HANDLING UNIT CFM
ADDRESS � ��f0 YL
` BOILER BTU CITY f`'deNO � 'f ��
COMPRESSOR BTU y`�'OQ /� &70 STAT LIC
LICENSE NO CLASS e-
VENTILATION SYSTEM DISTRICT NO GROUP I ZONE PROCESSED BY
EVAPORATIVE COOLER w O A/
-13 914
FURNACE FAU_GR&VITY �' �� INSPECTION RECORD
FLOOR BTU VIV On�—
HEATER SUSPENDED—UNIT—
WALL
USPENDED UNIT_WALL v
W
J
t%.
I C
CD
Plan checl. fee 25p10 of above See re%erse
LU
PERNIIC ISSURNG FEL 8 3 00 F-
IOTAL FEF 133 1 040
PLAN CHECK APPLICANT
,NAME
iADDRESS
11CITY TEL NO
I I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
(.,NoSTATE 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 AM NOT ACTING IN VIOLATION
F CHAPTER 9 DIVIS09 3 OF THE BUSINESS AND PR SSIONAL FINAL �lu
ODE OF THE STATE F ALIFO IA
SIGNATURE ERMIT VALIDATION ,, c`K t M 0 CASH
OF PERMITTEE ��.�
r
-PLAN CHECK VALIDATION CK M 0 CASH
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE