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APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS ! t
BUILDING AND SAFETY DIVISION ,
JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY
COLEMAN W.JENKINS,SUPERINTENDENT OF BUILDING NEAREST n
CROSS ST.
FOR APPLICANT TO FILL IN OWNER C'LG
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS 3 () C�YYZ�n yr
ABSORPTION SYSTEM, BTU OC! CITY P1 c- �m TESL. N0. T
AIR HANDLING UNIT, CFM I�?ro� V CONTRACTOR/ - 3
ADDRESS I �Z
BOILER, HORSEPOWER
CITY C� 11�..r�,v:�C TEL. NO-44 "'-I)fl
COMPRESSOR, HORSEPOWERSATEQ- �7
LICENSE NO. 2'60�� r CLASS^ 2'6
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER
FURNACE: FAU GRAVITY l/
FLOOR BTU INS PE N R RD
HEATER: SUSPENDED UNIT
WALL
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NEW_ADDITION_ PERMIT $ 3 00
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ALTER_REPAIR_ TOTAL FEE $ a
PLAN CHECK APPLICANT
NAME -,AP-C D q/�
ADDRESS 'I `j2 ,oA
CITY �� TEL. NO
IHEREBY 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 INS E TOR'S SIGNATURE
LATING, AIR CONDITIONING.
I HEREBY CERTIFY THAT I AM T ACTING IN VIOLATION OF
ROUGH
CHAPTER 9, DIVISION 3, OF THE SINESS AND PROFESSIONAL FINAL
CODE OF THE STAT 0 CALI OR
SIGNATURE JACK R. ALLEN, SUPERV MECHANICAL' EN6.'R.
OF PERMITTEE PERMIT VALIDATION CK. M.O. CASH;'
PLAN CHECK VALIDATION [ (1 / k 1 'I 0.0
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SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE ��