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APPLICATION FOR PERMIT
HEATING - VENTILATING -.AIR CONDITIONING
COUNTY OF LOS ANGELES, AUDI RDESS
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY
N EAREST
CROSS ST.
FOR APPLICANT Ta FILL IN OWNER
(PRINT OR TYPE ONLY) `
MAIL
NO. TYPE&SIZE OF EQUIPMENT FEE ADDRESS
ARE BACK OF A_PrLICATION
CITY TEL. NO.
FORCE AIR FURNACE, BTU �L
CONTRACTOR
COMPRESSOR, BTU
ADDRESS
VENTILATION FAN CITY EL. NO
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LIST ALL OTHERS BELOW STATELIC.
LICENSE N O. CL
[ROUP ZONE PR67AFbY
INSPECTION RE'
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Plan check fee. See reverse.
PERMIT ISSI;ING FF',E
TOT.4I, F-F: :Tpo
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HERESY ACKNOWLEDGE THAT I HAVE READ Tull APPLICATION •-,
AND STATE THAT THE ABOVE I! CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPICTON'G SIGNATURE
LATIN[. AIR CONDITIONING.
RO UG H
I HERESY CERTIFY AT I AM NOT TING IN VIOLATION
OF ,
DIVISIO OF TH[ BU AN PROFESSIONAL FINAL 1 '7-
COD[ OF THE STA7E ALIFOR IA.
SIONATURE PERMIT VALIDATION CK. M.O. CASH
OF PERMITTE
PLAN CHECK VALID.A410N CK. CASH
924 . 1411
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