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APPLICATION, FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES AbDRESS Obx/O oip" 'sr
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ; LOCALITY�� G?'*
NEA
RESTbl
CROSS ST. / � LCI ! /�
FOR APPLICANT TO FILL IN OWNER' n
(PRINT OR TYPE ONLY) '7� �
MAIL
NO. TYPE&SIZE OF EQUIPMENT ADDRESS Q 0 4bod /, 1J 157-
SEE
57-
SEE BACK OF APPLICATION de
FORCE AIR FURNACE, BTU CITY-re ' Z CJ TEL. NO-01/3-37910
CONTRALTO
COMPRESSOR, BTU ���
ADDRESS A--
VENTILATION FAN CITY TEL. NO.
LIST ALL OTHERS BELOW STATE LIC.
LICENSE NO. CLASS
DISTRICT NO. GROUP ZONE PROCESSED BY
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Plan check fee. See reverse. z
PRR191T I54I;ING FEE S
PLAN CHECK APPLICANT
NAME
4 ADDRESS
CI TY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
•a AND STATE THAT THE ABOVE 15 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 A T ACTING IN VIOLATION ROUGH 2'�5.Y 1;
OF CHAPTER 9, DIVISION 3, OMJ TUe BUS114ESS AND PROF SIDNAL FINAL /' J/� !�,// ✓
CODE OFT STA E CAL N /�V
1 OF 'y TT E,�! ►'T'� �GtiLR PERMIT VALIDATION CK. M.0. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
3' 3 6 r, r-. 16 4 1 D 2 3.2 5 ,wid