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AP.PLIQMION FOR PE-R#IT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES F
DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION,
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRESS e
CITY `� TEL. NO.
ABSORPTION UNIT, BTU
CONTRACTOR G
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU CITY % �rn//�� n� /�L/�NQO�.
COMPRESSOR, BTU STATELICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE P Es D BY
f
EVAPORATIVE COOL ��
FURNACE: FAU_GRAVITY INSPECTION RECORD
FLOOR BTU O
HEATER: SUSPENDED-UNIT-
WALL
USPENDED UNIT_WALL
• � 1 O
v
o
v
W
O-
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Plan check fee 25% of above. See reverse.
PERMIT ISSUING FEE S 3 00
TOTAL.FEE . 31*
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY = - _ "' TEL.NOc- "
LATING,
BY.ACKNOWLEDGE THAT I HAVE.READ THIS APPLICATION
E THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
ORDINANCES AND LAWS REGULATING HEATING, VENT[- APPROVALS DATE INSPECTOR'S SIGNATURE
IR CONDITIONING.
EBY CERTIFY THAT 1 AM NOT ACTING IN VIOLATION ROUGHER 9, D'IVISIO 3, OF TAU I SS AND PROFESSIONAL FINALTHE STATE A.URE PERMIT VALIDATION CM.O. CASH
MITTEE
PLAN CHEC ALIDATION' CK. 0. CASH
7'41 u 1 :3:a-:0 A:98
.SEE BACK OF APPLICATION FOR COM PLETE FEE SCNFOIII F .11n '