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TAAil�C
GB aIa[REV enp
�. 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
LOCALITY
NO TYPE OF APPLIANCE OR EQUIPMENT FE]ADDRESS NEAREST
CROSS ST
ABSORPTION UNIT BTU
OWNER
AIR HANDLING UNIT CFM MAIL
�y
BOILER BTU CITY TEL.NOS— 5-
COMPRESSOR BTU CONTRALTO ✓ G
VENTILATION SYSTEM
ADDRESS 0001
EVAPORATIVE COOLER
CT' TEL N 2
FURNACE FAU_GRAVITY STATE n LIC /+
FLOOR BTU LICENSE NO �Z CLASS C 20
HEATER SUSPENDED_UNIT_ APMOVALS DA IN5PECTOB sIONATu E
WALL
O ROUGH L
FINAL {/
INSPECTION RECORD V
m
Plan check fee 25% of above
PERMT ISSUING FEE;
TOTAL FEE
PLAN CHECK APPLICANTPLAN CHECK VALIDATION
NAME
ADDRESS
CIT TEL NO
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND 2 7 4 2 1 A
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL N
ORDINANCES AND LAWS REGULATING HEATING VENTILATING AIR # •'• 41
CONDITIONING I PERMIT VALIDATION
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF I - 2700
CHAPTER B DIVISION 3 OF THE BUSINESS AND PROFESSIONAL CODE
OF THE STATE OF CALI IA q xx
SIGNATUREA j V G 7,O 02i
OFPERM RTE /�
DISTRICT NO p PR ED BY I �,{215'_7 9
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