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76 A35 M ED IS - 9 T1 APPLICATION FOR PERMIT
BEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS SD
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
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NO YPEOFAPPLIANCEOR EQUIPMENT FEE ADDRESS
CITY L NO
ABSORPTION UNIT BTU U
CONTRACTISR
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU CITY TEL NO —
COMPRESSOR, BTU STA •q� G LIC LAS
C.
LICENSE NO ! q L7
VENTILATION SYSTEM DISTRICT No DROOP ZONE PR e!!Eo BY
EVAPORATIVE COOLER —t
j3TG/Z. a
d
J FURNACE FA AVITY
/ FLOOR BTU INSPECTION RECORD
HEATER SUSPENDED—UNIT—
WALL O L• w
-1 OAAjr, N
It
f 0
Plan rhecl, fee 25' of abo•e See re,,me '
Pl'R\ll I ISSIIING FLF, E 3 00
tOIAI I I L /3 ( 1
PLAN CHECK APPLICANT
NAME II
ADDRESS
CITY TEL NO
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND !TATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCE! AND LAWS REGULATING HEATING VENTI APPROVAL! DAT 9f9ECTOR S SIGNATURE
LATINO AIR CONDITION I NO
ROUGH
I HEREBY CERTIFY THAT I AM NOTCTING IN VIOLATION /
OF CHAPTER 9 DIVISION 3 OF THE BVlI ! ANO OiEIBIONAL FINAL
CODE OF THE ISTATE OI CALI RNIA
SIGNATURE PERMIT VALIDATION CK M G CA'
SPERMITTEE
PLAN CHECWVALIDATION CK M 0 CASH
41 O t-hC,L 04 i o 1 3.v v -z)c
SEE BACK OF APPLICATION'OR_COMLLETE FEE SCHEDULE