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76A364- CE 818-1/75
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELESBUILDING
REIt
DEPARTMENT OF COUNTY ENGINEER ADDSS _ �► r
BUILDING AND SAFETY DIVISION LOCALITY j y
NEAREST
CROSS ST. r
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) •'f
MAI L
No. TYPE&SIZE OF EQUIPMENT FSE ADDRESS
SEE BACK OF APPLICATION --
CITY TEL. NO.
FORCE AIR FURNACE, BTU `a` r
r CONTRACTOR �i r� L/{ _� /0
COMPRESSOR, BTU �* � j .r �ItC /
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VENTILATION FAN ADDRESS
CITY r TEL. NO. `"1 7
LIST ALL OTHERS BELOW STATE LIC.
LICENSE NO. ++ CLASS
^(STRICT N0. GROUP (ONE ,r,PR'PCSESS EC B1-
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INSPECTION RECORD O
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Plan check fee. See reverse.
PF:It111 I I��I I\(: FF:F: 3 00
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO,
I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -
WITH ALL ORDINANCESAND LAWS REGULATING HEATING, VENII- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING.
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, pIVIm1i
E BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STATE A.SIGNATURE PERMIT VALIDATION • cK.l; M.O. CAs-
OF PERMITTEE �
PLAN CHECK VALIDATION CK_ M.0. CASH