HomeMy Public PortalAbout5834 PRIMROSE AVE_Mechanical__ &M
y384 - CE SIB - 9-" APPLICATION R PER.
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING �' /1 /-/ �/ 11y(_ 0S
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY �' -
NEAREST ` S ��1
CROSS ST. ,4 6�
FOR APPLICANT TO FILL IN
(PRINT
(PRINT OR TYPE ONLY) OWNER I/we �i
MAIL ^A aA
NO. TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRESS �J /tet/
CITY TEL. NO.
ABSORPTION UNIT, BTU
CONTRACTOR
AIR HANDLING UNIT, CFM 51:010-f ADDRESS tol :0
BOILER, BTU CITY- kfl � NO. 1+/8"�
COMPRESSOR, BTU STATEL-1 C.
LICENSE NOI.�Ir ? el-I ` CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE - CE55ED BY
49
EVAPORATIVE COOLER � �27
� � OFURNACE: FAU_GRAVITY
FLOOR BTU INSPECTION RECORD v
1 i-
HEATER: SUSP UNIT_
WA L Lu
W
- LL
N
' Z
Plan check fee 25% of above. See reverse.
PERMIT ISSUING FEE S' 3 00
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I 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 D TE PECTOR'S IG TURE
LATING,AIR CONDITIONING.
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION ROUGH
. 16
OF CHAPTER 9, DIVISION 3, OF THE BNE59 AND PROFESSIONAL FINAL
CODE OF THE STATE OF CALIFORNIA.
1;�='mee�
SIGNATURE PERMIT VALIDATI .N cK. M.O. cn'sH�
OF PERMITTEE -
PLAN CHECK VALIDATION CK. M.O. CASH T
I r r.
1. Goo 9 '6, '! MAR 1.5 4 1 D 8.00—
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE