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76A364-CE818-1/70 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING 9 n jj
DEPARTMENT OF COUNTY ENGINEER ADDRESS /
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) MAIL
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NO. TYPEOFAPPLIANCEOR EQUIPMENT FEE
ADDRESS q/7Ole rYd
CITY ern �� TEL. NO. 66, -/&Jv
ABSORPTION SYSTEM, BTU �.,,�� J
AIR HANDLING UNIT, CFM CONTRACTOR/ R aO/Jo I. h! 5`7 v.J
ADDRESS SG��.') ��� ��x
BOILER, HORSEPOWER t
.y CITY��1'rl �� 6,,J(/ TEL. NO.?
COMPRESSOR, HORSEPOWER G / STATE LI C.
,LICENSE N 94 �� CLASS
VENTILATION SYSTEM DISTRICT NO. CLASS I GROUP ZONE PROCE D BY
EVAPORATIVE COOLER �J'aCJ
FURNACE: FAU G AN41TY INSPECTION RECOR
FLOOR BTU JUV, 000
HEATER: SUSPENDED—UNIT—
WALL
USPENDED UNIT_WALL W
-7
NEW—ADDITION— PERMIT $ 0 r
ALTER_REPAIR_ TOTAL FEE $
PLAN CHECK APPLICANT n� 1 ' 7� . I�Z✓
NAME I J 0
ADDRESS i /I"CU
t
CITY TEL.NO.
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION -
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMELY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING.
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF THE BUSINE ¢ AND PROFESSIONAL t; FINAL
CODE OF THE STATE EOFAlIFOitSIGNATURE JACK R. ALLEN,SUR ISING CHANICAL ENG'R.
OF PERMITTEE
PERMIT VALIDATI N fCK. M.O. CASH
PLAN CHECK VALIDAT40N
7 3 3 i;APR 15 41 ® 1 9.5'.0
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE