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LICATION FO�PERMIT
HEATING. - VENTILATING'- AIR CONDITIONING
COUNTY OF LOS ANGELES FADDRESS
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DEPARTMENT OF COUNTY ENGINEER Al-
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN OWNER `
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRESS
CITY TEL. NO
ABSORPTION UNIT, BTU
CONTRACTOR
-AIR HANDLING-UNIT, CFM
ADDRESS
BOILER, BTU CITY TEL. NO.-
COMPRESSOR, BTU STATE LIC.
LICENSE NO. CLASS,
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE EBBED BY
EVAPORATIVE COOLER ��Q�° 1
FURNACE. FAU_GRAVITY
FLOOR BTU INSPECTION RECORD
HEATER: SUSPENDED UNIT_ ��
WALL
O
U
CC
' O
. F-
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a
N
Plan check fee 25% of above. See reverse.
PERMIT ISSUING FEE S 3 00
TOTAL FEE h 16)()
PLAN CHEC APPLICANT
NAME
ADDRESS
CI TY T O.
i HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING.
I HEREBY CERTIFY 1 AM NOT ACTING IN VIOLATION ROUGH
OF CHAPTER 9, DIVISI y OF HE BUSINES R ESSIONAL FINAL
CODE OF THE STATE CA I NIA. j
SIGNATURE PERMIT VALIDATION cK M.O. CASH
OF PERMITTEE r
PLAN CHECK M. .
8 4•3i'v`MAY' ;6.4'1 D 8.0 0 A98
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE