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79A364 — CE.818 — 3-69 APPLICATION FOR PERMIT a
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION
JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY
'.:OLEMAN W.JENKINS,SUPERINTENDENT OF BUILDING NEAREST
CROSS ST. !
FOR APPLICANT TO FILL IN �y
OWNER
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
ABSORPTION SYSTEM, BTU CITY;22f EL. NO."7-7' zo
i'
CONTRACTOR
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, HORSEPOWER
CITY TEL. NO.
COMPRESSOR, HORSEPOWER STATE LIC.
LICENSE N0. CLASS �
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PR CESSED BY
EVAPORATIVE COOLER ` _�
FURNACE: FAU GRAVITY
FLOOR BTU INSPEC-TION RECORD
HEATER: SUSPE ED UNIT A
WALL �� 1") (! i
I
1
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NEW ADDITION_ PERMI T $ 3 00
ALTER_REPAIR_ TOTAL FEE $ .Q
PLAN CHECK APPLICANT
NAME
ADDRESS
S CITY' "2:k TEL. N0. r
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
k. WITH ALL ORDINANCES AND LAWS REGULATING HEATING,VENTI-
LATING.AIR CONDITIONING. APPROVALS DATE INSP CTOR'S SIGNATURE
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH
t; CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL ,
t. CODE OF THE STATE OF/CAL�19
IIF NIA. &421 P
SIGNATURE �_ J i�w.a�/Tal JACK R. ALLEN, SUP RVI NG MECHANICAL ENG'R.
OF PERMITTEE �I��/// E
PERMIT VALID�T_IO�I CK- • M.o. CASH
4 PLAN CHECK VALIDATION
66584 JUM26 41 D 8." ON q
-E BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE