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APPLICATIO FOR PERM .
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF 'LOS ANGELES AD RES ��3nolo� I
DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY / �' c.NEAREST
CROSS ST:FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
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NO. TYPE OF APPLIANCE OR EQUIPMENT FEE AABSORPTION UNIT, BTU DDRESS '1-00CITY TEL. NO.---
� 139CONTRACTAIR HANDLING UNIT, CFM
BOILER, BTU ADDRESS
CITY. TEL. NO. '?SC)-L%
COMPRESSOR, BTU 6O STATE r LI'C, a�
LICENSE NO. �1 f-gl Z-, CLASS�� .
VENTILATION-SYSTEM DISTRICT N0. GROUP ZONEOIL CESSED BY
EVAPORATIVE CO LER . G 0 ��J
FURNACE: FAU_GRA ITY
FLOOR BTU O 130 INSPECTION RECORD
HEATER: .SUSPENDED UNIT_
WALL Li
CD
C.D
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CD
F-
V
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N
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Plan check fee 25% of above. See reverse.
PERMIT ISSUING FZE 3 0
TOTAL FEE (eq,f0
PLAN CHECK APPLICANT
NAME `
ADDRESS
CITY TEL.NO.
LLATING,
BY ACKNOWLEDGE THAT I HAVE.READ THIS APPLICATION
E THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
IR CONDITIONING. ROUGHEBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
ER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL. FINALTHE STATE OF CALIFORNIA.
URE PERMIT VALIDATION cK. M.O. CASH
MITTEE
PLAN CHECK VALIDATION CK, M.O. CASH
2 .50ticR 1.941 64.50 &13
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