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AP CATION FOR`PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS�OJ% PER 5110 M O
BUILDING AND SAFETY DIVISION LOCALITY-I-G 1 A-E C
NEAREST
CROSS ST. C S
FOR APPLICANT TO FILL IN ;OWNER /�
IPRI NT OR TYPE ONLY) 7 -4 . /0 -Lf�
/
MAIL
?. N0. TYPE&SIZE OF EQUIPMENT FEE ADDRESS U5S"/N IVB
SEE BACK OF APPLICATION
CITY T_ TEL. N
FORCE AIR FURNACE, BTU !
CONTRACTOR ,,
COMPRESSOR, BTU
ADDRESS
VENTILATION FAN CITY '/ TEL. NO
LIST ALL OTHERS BELOW LICENSE NO. / / CLASS
U DISTRICT NO. GrRO-UP I ZONE ESSED BY
0 8 1 9, C2.
INSPECTION RECORD
EL
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O
F-
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13-
Plan
LPlan check fee. See reverse.
Z
' I'I-:TIMI' IXtil 1\(: FEE S 3 00
PLAN CHECK APPLICANT
NAME
ADDRESS
2
CITY TEL.NO
I HEREBY 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, VEN71- APPROVALS DATE INSPECTOR'S SIGNATURE
EATING.AIR CONDITIONING.
ROUGH
I HEREBY CERTIFY THAT N A I VIOL TI �
OF CHAPTER 9, DIVISION 3, B INE P ES FINAL
CODE OF THE STATE OF CA IA. (..•'�7i� / �-'C
OFNATUR
PERMITTEE PERMIT VALIDATION ; CK. 0. CASH
PLAN CHECK VALIDATION CK. M.O. c H
47302JUL 1641 O 8.00 •�Ia
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