HomeMy Public PortalAbout5313-5315 VILLAGE CIRCLE DR_Mechanical__ 76 A364- CE 816- 5-73
APPLICATION FOR PERMIT
HEATING VENTILATING - AIR CONDITIONING
COUNTY OF LOS BUILDING
DEPARTMENT OF COUN YGELES ENG NEER ADDRESS
ADDRESS. S+•'
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST. 111
FOR APPLICANT TO FILL IN OWNER '� -
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRESS r9100
CITY TEL. NO. ��
ABSORPTION UNIT, BTU
CONTRACTOW
AIR HANDLING UNIT, CFM
ADDRESS i�
BOILER, BTU tSTAE
TEL. NO. 3� #X Q
y COMPRESSOR, BTU �!'L f LIC.
y CLASS GZl7
VENTILATION SYSTEM GROUP ZONE PROCES D BY
EVAPORATIVE COOLERFURNACE: FAUGR VITYINSPECTION RECORD
FLOOR BTU I
HEATER: SUSPENDED-UNIT-
WALL
USPENDED UNIT_WALL �.
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Plan chick fee 25%of above. See reverse. '
PERMIT ISSUING FEE S
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
LBY ACKNOWLEDGE THAT i HAVE READ THIS.APPLI CATION
E THAT THECABOVE 15 CORRECT AND AGREE TO COMPLY
ORDINANCES AND LAWS REGULATING HEATING, VENT.1- APPROVALS DATE INSP�,T�OR'9 SIGNATURE
IR'CONDITIONING.EBY CERTIFY THAT I AM NOT ACTING IN VIOLATION ROUGHER 9, DIVISION 3 01 THE SUSIN SS AND PROFESSIONAL FINALTHE STATE OF IFOR NIA.URE PERMIT VALIDATION CK. M.O. CASH
MITTEE
PLAN CHECK VALIDATION CK. M.O. CASH
1 5 3r--FEB 11 4 1 .0 3. 4-.n U ;3
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