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76x364 _ CE818 3-69 APPLICATION FOIT" /� CLc
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HEATING - VENTILATING - AIR CONDITIONING y��(
COUNTY OF LOS ANGELESBULD ING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION r
JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY /
COLEMAN W.JENKINS,SUPERINTENDENT OF BUI,LDING 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. c�
AIR HANDLING UNIT, CFM CONTRACTOR
ADDRESS /
BOILER, HORSEPOWER y/
CITY �� dry TOE N
COMPRESSOR, HORSEPOWER STATE' LIC.
LICENSE NO. CLAS +ZU,
VENTILATION SYSTEM -DISTRICT N0. GROUP ZONE PRO'�CESS��EDA�BY
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EVAPORATIVE COOLER 0'r
FURNACE:
FURNACE: FAU GRAVITY
FLOOR BTU INSPECTION RECORD
HEATER: SUSPENDED-UNIT-
WALL
USPENDEDUNITWALL Ze!f:
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NEW_ADDITION_ PERMIT $ 3 00 Z
ALTER REPAIR_ TOTAL FEE $
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.N0.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION f�
AND STATE THAT THE ABOV IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES A LAWS REGULATING HEATING,VENTI- APPROVALS D TE IN CTOR'S SI ATURE
EATING,AIR CoNDITIONIN . _
I HEREBY CERTIFY T 1 AM NOT ACTING IN VIOLATION 'F ROUGH
CHAPTER 9., DIVISION 3 F THE BUSINESS AND FESSI' L FINAL
CODE OF THE STATE OF IFORNIA, l+
SIGNATURE JACK R. ALLEN, SU ERVIUNkMECHANICAL ENG'R.
OF PERMIT E
PERMIT VALIDATIONcK._. M.o. LASH
PLAN CHECK VALIDATION
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SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE _,Y ) r.„ ••