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APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING 21/ _ LE •r V
DEPARTMENT OF COUNTY ENGINEER ADDRESS :J lY
BUILDING AND SAFETY DIVISION LOCALITY !�`,/ t-: "�I
CROSSST LOM&D£N1
FOR APPLICANT TO FILL IN OWNER �(�� WI�G��
(PRINT OR TYPE ONLY) „ /� /n� ••'' 11L
ADDRESS .1 s N - /-. gAkkQ V G -
NO TYPEpF APPLIANCE OR EQUIPMENT PEE n f1
ABSORPTION UNIT BTU CITY✓1 5A (SABRICLTEL NO �U-5 0)003
CONT✓RACTOR^ r t e
AIR HANDLING UNIT, CFM vC
ADDRESS
BOILER, BTU
CITY A ZI LL_SA I-! TEL NO33 9_ rl- �I
COMPRESSOR BTU / STATE NO / CLIC
LASS x•
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VENTILATION SYSTEM DISTRICT NO eRouP /z ONE ED By
EVAPORATIVE COOLER Sod / 1/ L
FURNACE FAUGR VITY /D / INSPECTION RECORD
FLOOR BTU
HEATER SUSPENDED_UNIT_
WALL
A-
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O
U
CC
O
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W
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Plin check FPD 25% of abo,P Sce re,er.c z
PEII\IIT ISStII\C FF F S 00
IOIAI FEF 7
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINAN CCS AND LAWS REGULATING HEATING VENTI- APPROVALS DATE INSPECT !SIGNATURE
LATINO AIR CONDITIONING
ROUGH
HEREBY DIVISION
THAT E NOT ACTING IN VIOLATION
OF CHAPTER 9 DIVISION 3 0! THE BUSINESS AND PROFESSIONAL FINAL -���7
CODE OF THE STATE 0 CAL IIfOR MIA
SIGNATURE PERMIT VALIDATION E+ry� M 0 DASH
SPERMITTEE
PLAN CHECK VALIDATION :L \I'J' o Q H
I' ; ;OLDER- ' 2 4 1�AUG 10 41 0 2 7.0 0
POLICY NUMBER: �7 -6,1P -7;>
SEE BACK O!APPLCATION FOR COMPLETE FEE SCHEDULE `�