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• APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES ADDRESS 1 —
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCAL ITY—
NEAREST
CROSS ST.
FOR APPLICANT TO FILL 1N
OWNER
(PRINT OR TYPE ONLY) �•U /�� �+
MAIL "
NO TYPE&'SIZEOFEQUIPMENT FEE ADDRESS
SEE BACK OF APPLICATION
CIT NO.
FORCE AIR FURNACE, BTU
CONTRACT
COMPRESSOR, BTU
ADDRESS 19
VENTILATION FAN CITY CfEL. NO.
LIST ALL OTHERS BELOW STATE LIC. vva
LICENSE NO. ,/ CLASS
/J DISTRICT N0. GROUP ZONE 1,P;R�0FOPSEDBY
INSPECTION RECO
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Plan check fee. See reverse. z
PE:I1N11'I' Iti5I-1NG FU S
TOTAL, PEI,:
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES WS REGULATING HEATING, VENTI- APPROVALS DATE INS ECTOR'9 SIGNATURE
LAT ING.AIR CONDITION G.
ROUGH
.f
I HEREBY CERTIF THAT I AM T ACTING IN VIOLATION
OF CHAPTER 9, DIVISI 3, OF THE 1 SS AND PROFESSIONAL FINAL `
CODE OF THE STATE 0
SIGNATURE PERMIT VALIDATION cK. M.o. CASH
OF PERMITTEE '
PLAN CHECK VA (DATION .o. CASH
66 9 GGT 20 411. d 1 5.7 5 ��s