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76A364 - CES18 - 3-69 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING !TEN
DEPARTMENT OF COUNTY_ENGINEER ADDRESSBUILDING AND SAFETY DIVISION JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY
COLEMAN W.JENKINS,SUPERINTENDENT OF BUILDING NEAREST
MIIIIIIIIIIIIIIIICROSS ST.
FOR APPLICANT TO FILL IN(PRINT OR TYPE ONLY) OWNER
MAIL NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESSABSORPTION SYSTEM, BTU CICONTRACTO — A' L-
AIR HANDLING UNIT, CFMADDRESS BOILER, HORSEPOWERCOMPRESSOR, HORSEPOWER STATErvppC LCENSE NO. d0' aSS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE P ESSED BY _
EVAPORATIVE COOLER
FURNACE: FAU dUacoGRAVITY INSPECTION RECORD
/ FLOOR TU
HEATER: SUSPENDED UNIT
WALL
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NEW' ADDITION_ PERMIT $ 3 00
ALTEREPAIR_ TOTAL FEE $ �O
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION '
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING,VENTI-
LATING, AIR CONDITIONING. APPROVALS TE INACTOR'S NATURE
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH
CHAPTER 9, DIVISION 3,•OF THE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STA 0 CALIFORNIA. -
SIGNATURE JACK R. ALLEN, SUPER I MECHANICAL ENG'R.
OF PERMITTE PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION
0 5 4 9?3 WR 3 4 1 1 3,0 O N a
'EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE