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78 A364 -•.cE�81.6 9-71; AppLl ATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF'LOS ANGELES FNEAREST
S - j�
DEPARTMENT OF COUNTY ENGINEER ,
BUILDING AND SAFETY DIVISION T
T.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) J
MAIL - 01
No. TYPEOFAPPLIANCEOR EQUIPMENT FEE ADDRESS
Cly TEL. NO.
ABSORPTION UNIT, BTU
CONTRACTO
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU CITY TEL. N2� ,�/�fla
COMPRESSOR, BTU STA E �� CLASS
LICENSE NO.
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PREBBED BY
EVAPORATIVE COOLER
FURNACE: FAUGRAVITY QD
FLOOR BTU� -� INSPECTION RECO D w
HEATER: SUSPENDED UNIT_ _ ` v
WALL
a
y
. g
Plan check fee 25% of above. See reverse.
PERMIT ISSUING FEE 3 3 00
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
L
REBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -
LL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
AIR CONDITIONING.
ROUGH
EREBY CEOTIFY THAT I AM NOT ACTING IN VIOLATIONPTER 9, DIVISION 3, OF THE BUBINEB P EBSIO AL FINAL ,,✓ "'7,F THE STATE OF IFOIj1fl (. . k .
TURE PERMIT VALIDATION CK. M.O. CASH
RMITTEE
PLAN CHECK VALIDATION CK. M.O. CASH vw/
( 3 7 9 373 NOV2 0 4 1 D 1 0,5 QA IF
SEE RACK OF APPLICATION FOR COMPLETE FEE SCHEDULE