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APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BDIDRESS E L LVD-
DEPARTMENT OF COUNTY ENGINEER N
BUILDING AND SAFETY DIVISION LOCALITY MULE L_.IT
NEAREST I-1 m&DEN
CROSS ST 1 V �J
FOR APPLICANT TO FILL IN OWNERCF
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(PRINT OR TYPE ONLY) , 1 & 1I(—
MAIL 15 N RA WAIL MO -
NO TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS /' ��//��n (� IVl
ABSORPTION UNIT, BTU CITYS_ SAM Cj/i[J WL TEL NO 4 45 -d&0✓
A N p TG
AIR HANDLING UNIT, CFM CONTRACTOR E S Q)p
ADDRESS
BOILER, BTU CITY 5A TEL NO
COMPRESSOR, BTU 3D, otrO J D / STATELIC
LICENSE NO Q5r7S7 CLASS C^ dO
VENTILATION SYSTEM DISTRICT NocaouP ZDNE BED BY
EVAPORATIVE COOLER
FURNACE FAU_G ITY / INSPECTION RECORD
FLOOR BTU
HEATER SUSPENDED—
UNIT-WALL
CO
CO
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N
Plan eheck fee 21ST of bo%e See re,,r.e z
PVHVIII ISSUING FHM 3 00
01 \I MFF
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ANO STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING VENTI- APPROVALS DATE INSPECT SSIGNATURE
LAT ING AIR CONDITIONING
ROUGH /o/67b
HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER B DIVISION 3 OF THE BUSINESS AND PROFESSIONAL FINAL /Qj-7 �Tf1e
CODE OP THE STATE OF CALIFORNIA
SIGNATURE PERMIT VALIDATION �K�' `M 0 CASH
OF PERMITTEE
PLAN CHECK VALIDATION E -N,4ATIfS�11
I�
24O�AUG 1041 0 27.00A�-d
iOLDER:
FOLIGL ::UMBER: .y7s69- 717 _ IN-6.
SEE BACK OF APPLK ATION FOR COMPLETE FEESCHEDULE