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APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONOIiIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
No TYPE&SIZE C OF APPLICATION
FEE ADDRESS
SEE BACK OF APPLICATION
FORCE AIR FURNACE BTU CITY TEL NO 440/f-104
CONTRACTOR
COMPRESSOR BTU
ADDRESS
VENTILATION FAN CITY _ TEL NO
LIST ALL OTHERS BELOW STATE LIC
LICENSE NO CLASS
DISTRICT ND4POUP 20NE PROCESSED BY
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INSPECTION E ORD
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0
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%en check fee See reverse
1'111\111
101 11 I FI
PLAN CHECK APPLICANT
NAME
ADDRESS r7,9 L
CI TV TEL NO �y177,5
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMFLY
WITH ALLORDINANCES AND LAWS REGULATING HEATING VENTI APPROVALS DATE MS OR SIGILTURE
LATINO AIR CONDITIONING
ROUGH J
HEREBY DIVISION
THAT E NOT SS AND
IN VIOLATION
DF CH71
AF TER 9 DIVISION 3 OF THE BUSINESS
U 9��1��N E9 BA{{yyND PRO FEISIONAL FINAL
CODE OF THE STATE OF CALIFOPNI
SIGNV.W�' i
E URERMITTEE_
OF PPERMIT VALIDATION CK M o c.sN
OF PE
PLAN CHECK VALIDATION CA M 0 CASH
429�FEB 247. 0 19.50 •%a