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APPLICATION FOR PERMIT
HEATING VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES ADDRESS �•��V �/C S1�9I�Id
DEPARTMENT OF COUNTY ENGINEER
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BUILDING AND SAFETY DIVISION LOCALITY 7Wyhl Ls (!/7-P
JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDINGNEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER p p �,L/�T�
(PRINT OR TYPE ONLY) MAIL d/�
ADDRESS �3 s-0
NO. TYPEOFAPPLIANCE•OR EQUIPMENT FEE /
CITY-7,-Z7/fJl I •:U TEL. NO.
ABSORPTION SYSTEM, BTU �!1
CONTRACTOR
AIR HANDLING UNIT, CFM �/ p
ADDRESS 5 aJ'
BOILER, HORSEPOWER CITY G�S &7il TEL. NO. -7
COMPRESSOR, HORSEPOWER STATE LIC.
LICENSE NO. a laPI �� CLASS
VENTILATION SYSTEM DISTRICT NO. CLASS GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER __�p 1, lr'rIR
FURNACE: FAU_GRAVITY_ INSPECTION RECORD
FLOOR BTU O
HEATER: SUSPENDED UNIT_
WALL
6_7 /1
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NEW—ADDITION— PERMIT $ 3 00 a
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ALTER-REPAIR- TOTAL FEE $
PLAN CHECK APPLICANT
NAME
ADDRESS
Cl TY TEL.NO.
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
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.
ROUGH -
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, THE BUSINESS AND PROFESSIQNAt FINAL (�-
CODE OF THE STATE OF CAL F NIA.
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SIGNATURE ���� JACK R. ALLEN,SUPERVISI MECHANICAL ENG'R.
OF PERMITTEE C�I��
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION
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; 7 7 5c FEB 17 4.1. D 1.1,G0N
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE