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APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING �m
DEPARTMENT OF COUNTY.ENGINEER ADDRESS -
BUILDING AND SAFETY DIVISION LOCALITY n1 I
NEAREST
CROSS ST. - �-
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) C
MAIL
No. TYPEOFAPPLIANCEOR EQUIPMENT FEE ADDRESS
CITY l C!If TEL. NO. V,2
ABSORPTION UNIT, BTU
CONTRALTO �
AIR HANDLING UNIT, CFM ADDRESS
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BOILER, BTU
CITY` r�: L TEL. NO. 3`701
COMPRESSOR, BTU STATELid.
LICENSE NO, a i� CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PRO SSED BY
EVAPORATIVE COOLER _
FURNACE: FAU_GRAVITY
FLOOR BTU INS
/PECTION RE ORD ty
HEATER: WALLENDED UNIT_ !} \? ��tN �j'l'riy 1� '1Gr!/r`li%'.r;�-+ }
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Plan check fee 25% of above. See reverse.
PERMIT ISSUING FEE S 3 00
TOTAL FEE OO
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT 1 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.
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL {; ��
CODE OF THE STATE 0 CALIF IA. I
SIGNATURE , PERMIT VALIDATION CK. M.O. CASH
OF PERMITTEE
PLAN CHECK VALIDATION CK. M.O. CASH
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE v