HomeMy Public PortalAbout4902 TEMPLE CITY BLVD_Mechanical__ TeAxsc � -
CE @IS IR•V e/Tel
®. 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 D��
LOCALITY
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROSS ST
ABSORPTION UNIT BTU
OWNER �p
AIR HANDLING UNIT CFM MAIL
ADDRESS
BOILER BTU ' CITY TEL NO /
COMPRESSOR BTU CONTRACTOR-:j5pX yr
VENTILATION SYSTEM ADDRESS
Ae
EVAPORATIVE COOLER CITY TEL NO�-
FURNACE FAU_GRAVT' STATE �i / LIC
FLOOR BTU LICENSE a CLASS
HEATER SUSPENDED—UNIT— APPROVALS DATEIHSP ion SS 5NAWRE
WALL
— I
ROUGH �/ SZZ 7FINAL CN// I J0I1-79'] 0
INSPECTION RECORD u
09
O
Plan check fee 25% of above
PERMIT ISSUING FEE f _
TOTAL FEE
PLAN CHECK APPLICAN ` f /L PLAN CHECK VALIDATION
NAME
ADDRESS
fw 90 0
CITY TEL NO -7((d
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL -2 4 3,12 A
ORDINANCES AND U S REGULATING HEATING VENTILATING AIR
CONDITIONINGI PERMIT VALIDATION # • • • • U 1
1 HEREBY C IFY THAT I AM N ACTING IN VIOLATION OF
CHAPTER 9 DIVI N 3 OF THE SUSI SS AND PROFESSIONAL CODE 21• • ' Z 0 O
OF THE STATE O ALIFORNIA J
SIGNATURE
3006
OF P NATURE I•
DISTRICT NO PROC 8YO_p ` 0511 '-79 CU 1 1 —7 9
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