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76AS64C
CE—818(REV.11/78)
®: APPLICATION FOR PERMIT
HEATING - VENTILATING = AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING
(PRINT OR TYPE ONLY) ADDRESS
L �.
NO. TYPE OF APPLIANCE,OR EQUIPMENT FEE LOCALITY
NEAREST
CROSS ST.
ABSORPTION UNIT,BTU
OWNER do
AIR HANDLING UNIT,CFM MAIL
ADDRESS 1 (/
BOILER,BTU CIT TEL.
i
COMPRESSOR,BTU CONTRAC
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CITY TEL.
FURNACE: FAU G. �(ITY STA LIC.
FLOOR BTU LICENSE NO. CLASS
HEATER: SUSPENDED UNIT_ APPROVALS DATE INSPECTOR'S SIGNATURE
WALL
ROUGH1 4 — k
FINAL ,30" ff O
v
INSPECTION RECORK Cs
0
Plan check fee 25%of above.
w
PERMIT ISSUING FEE$
TOTAL FEE
PLAN CHECK APPLICANT PLAN CHECK VALIDATION
NAME
ADDRESS
CITY TEL.NO.
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND n
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL 1 5 A
ORDINANCES AND LAWS REGULATING HEATING, VENTILATING, AIR
CONDITIONING. I PERMIT VALIDATION
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF
CHAPTER 9, DIVISIO 3, OF THE BUSINESS AND PROFESSIONAL CODE 2 0 o 1 7.0 0
OF THE STAT AL
SORAIA.
IGNATUR O O o 1 7 C C L
F
PERM zap
DISTRICT'NO. nyN PROCESSED Y 1 205-79
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