HomeMy Public PortalAbout6149 ROSEMEAD BLVD_Mechanical__ 76 A364'CE 818.1/75
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONOITIONING
COUNTY OF LOS ANGELES BUILDING zzzzo
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
J.'ICROSS ST.
FOR APPLICANT TO FILL 1N OWNER `
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE&SIZE OF EQUIPMENT FEE ADDRESS
SEE BACK OF APPLICATION '
CIT G TEL. NO.,,feor
FORCE AIR FURNACE, BTU
CONTRACTOR `
COMPRESSOR, BTU
ADDRESS��,�� �.
VENTILATION FAN I r
CITY NO. oe3311�
LIST ALL OTHERS BELOW STATE LIC.
LICENSE NO. CLASS
r DISTRICT NO. GROUP ZONE PROCESSED BY
INSPECTION RECORD
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Plan check fee. See reverse. Z
PI-11111T ISSUI\G FEE S 360
TOTAL FE1: pV
-PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
1 HEREBY ACKNOWLEDGE THAT I 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 HE BUSINESS AND PROFESSIONAL FINAL 3 r7r7
CODE OF THE STATE OFC 1 �
SIGNATURE
OF PERMITTEE PERMIT VALIDATION i CK. M.O. CASH
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PLAN CHECK VALIDATION CK. M.O. CASH
449fi0.CT 1241 D 1 2.00 '&�Jd