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7gA364 - CESIS - 3 69 APPLICATION FOR PERM
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING i
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION
JOHN A LAMBIE COUNTY ENGINEER LOCALITY
COLEMAN W JENKINS SUPERINTENDENT OF BUILDING NEAREST
CROSS ST
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
ABSORPTION SYSTEM BTU CITY TEL NO 1
29
AIR HANDLING UNIT CFM CONTRACTOR
ADDRESS
BOILER HORSEPOWER
CITY TEL NO // G
COMPRESSOR HORSEPOWER STATE LIC
L CENSE 0 CLASS
VENTILATION SYSTEM DISTRICT NO GROUP OZONE PROCESSED BY
EVAPORATIVE COOLER s, // `�
FURNACE FAU GRAVITY �J �!�
RD
FLOOR BTU INSPECTION RECO
HEATER SUSPENDED UNIT 17,_ I�G�G evL
WALL I
d
O
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1
V
W
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N � PERMIT $ 3 00
NEW—ADDITION
Z
ALTER--REPAIR_ TOTAL FEE $
AN CHECK APPLICANT
NAME
ADDRESSK, ,qt
CITY07
NO 0 W117
IHEREBY &KNOWLEDGE HAT I HAVE READ THIS APPLICATION
AND STATE HAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING VENTI APPROVALS DATE INSPECTOR S SIGNATURE
LATING AIR CONDITIONING
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH
CHAPTER 9 DIVISION 3 OF THE BUSINESS AND PROFE IONAL FINAL
CODE OF THE STAT A, RNIA
SIGNATURE JACK R ALLEN SUPERVISING MECHANICAL ENG R
OF PERMITTEE
PERMIT VALIDATION CK M o CASH
PLAN CHECK VALIDATION
0-FE6 7 UEC 17 4, 1 D 7 00-
FE
BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE ��