HomeMy Public PortalAbout5403 PERSIMMON AVE_Mechanical__ 76 A364- CE 818-1/75 %% '
APPLICATION FOR PERMI
HEATING - VENTILATIN.'G -- AIR CONDITIONING
COUNTY OF LOS ANGELES ADDRDcNG
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DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY ��
NEAREST
CROSS ST. �cI
FOR APPLICANT TO FILL IN
OWNER
(PRINT OR TYPE ONLY)
MAIL
TYPE&SIZE OF EQUIPMENT ADDRESS
NO. SEE BACK OF APPLICATION FEE �.S•
CITY C 1 TEL. NO. �?_ff S'6 2
FORCE AIR FURNACE, BTU O
CONTRACTOR'_
COMPRESSOR, BTU b �• e a x
ADDRESS "3/D � i,
VENTILATION FAN CITY , _ 4., TEL. N 0
LIST ALL OTHERS BELOW STATE . LIC. C'-2_6
LICENSE NO. 2LI��S.� CLASS C—
DISTRICT N0. GROUP �QNE P ESSED BY
�Y' ,JG 5 I
INSPECTION RECORD
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Plan check fee. See reverse.
F'F.R\11'I' itiSl'I\G FF;I: S 0
"i'0'i'Ai. Fl-'[-:
PLAN CHECK APPLICANT
NAME
ADDRESS
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, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING,AIR CONDITIONING. f
�.
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION ROUGH
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL 'FINAL ��?/�(� �I..-.,a
CODE OF THE STATE OF CA IFORNIA.
OF PE U ITTEE. t.� ,� PERMIT VALIDATION CK. M.O. CASH
'OF PERMITTEE �✓ �`
PLAN CHECK VALIDATION CK. M.O. CASH
9 6 O r'o-„nY 18 4 1 D 1 9.5 Q acs
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