HomeMy Public PortalAbout5515 PAL MAL AVE_Mechanical__ 76 A364 - CE 818 - 9-71 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES ADORESS 5YIS /V. Pj 0.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY C-
NEAitj
REST
CROSS ST. Dr,
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) A IM
MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADORESS /O
CITY -f+ ' TEL. NO. ]�D
I ABSORPTION UNIT, BTU 1
CONTRACTOR 10 yj A
AIR H LIN UNIT, CFM
1 if
ADDRESS
BOIL R, v CITY TEL. NO.
COMPRESSOR, BTU STATE LIC
LICENSE NO. CL
VENTILATION SYSTEM DISTRICT NO. OROOP ZONE
EVAPORATIVE COOLERDO S�� 63Tr�
0
FURNACE: FAUGRAVITY INSPECTION RECORD
FLOOR BTU p
HEATER: WAUSPHNDED_UNIT_
d
LL-
La R9 P Z
Plan check fee 25- of above. See reverse.
PERMIT ISSUING FEE $ 3 Oo
'IOTAI. FEE.
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOw LEDGE THAT HAVE READ THIS APPLICATION CATION
AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VEHTI- APPROVALS DATE 1KSPECTOR'!SIGNATURE
LATING� AIR CONDITIONING.
ROUGH
HEREBY CERTIFY THAT I AM NOT ACTING IH VIOLATION
OF CHAP TEP S. DIVISION L OF THE BUSINESS ANO PROFEl910NAL FINAL
CODE OF THE STATE OF
CALIFORNIA. �/
SIGNATURE PERMIT VALID ION CK. 1 M.O. CASH
OF PERMITTEE ldwkhm /
PLAN CHECK VALIDATI10N CK. M.O. CASH -'
5 b SVS APR 8 4 1 0.5 0 AzxD
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE