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®1 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL INTNEAREST
DING �` SE�/�♦� ,
(PRINT OR TYPE ONLY) RESS {/ LGN R
ALITY
NO TYPE OF APPLIANCE OR EQUIPMENT FE1
SS ST
ABSORPTION UNIT BTU
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AIR HANDLING UNIT CFM RESS
BOILER BTU
CITY 7-1 c` TEL NOn
LCOMPRESSOR BTU �� /O CONTRACTOR
VENTILATION SYSTEM
ADDRESS 3jj� E// f^
EVAPORATIVE COOLER
Cn-v ` , TEL N0284-
FURNACE FAU X GRAVITY STATE LIC
FLOOR BTU G LICENSE NO Q�$"OO C ASS
HEATER SUSPENDED UNIT_ APPROVALS DATE INSPECT
WAU W)Is sIGNAiu HE
ROUGH
FINAL e[— O
INSPE TION RECORD U
0
0
Plan check fee 25?6 of above
PERMIT ISSUING FEE;
TOTAL FEE 27
PAN CHECK APPLICANT PLAN CHECK VALIDATION
NAME L
ADDRESS
CITY TEL NOI THAT I HAVE READ !1 I1
AND
STATE THATBTHE ABO ELEDGE IS CORRECT AND AGR ETHIS TO COMPLYAPPLATION WIITH ALL R 4 9,7 A
ORDINANCES AND LAWS REGULATING HEATING VENTILATING AIR
CONDITIONING I PERMIT VALIDATION We e e e 4 1
1 HEREBY CERTIFY THAT I AM N A ING IN LA N OF 7,0 0
CHAPTER 9 DIVISION F THE BUST S D PRO O CODE Z e
OF THE STATE OF O A '
SIGNATURE 'e e e 'T�/ O O Tu
OFPERMITTEE • . C 2 /
DISTRICT NO P V Q J 2 2:-7 9
67