HomeMy Public PortalAbout5304 WELLAND AVE_Mechanical__ 76 A454- QE 8 18-1/75
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`'"' APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS rQ
BUILDING AND SAFETY DIVISION LOCALITY -
NEAREST
CROSS ST.
FOR-APPLICANT TO FILL IN OwNE
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE&SIZE OF EQUIPMENT FEE ADDRESS
SEE BACK OF APPLICATION
T
FORCE AIR FURNACE, BD CITEL. NO.TU
COMPRESSOR, BTU
CONTRAC OR
--
ADDRESS �
VENTILATION FAN CITY TEL. NO. ?i -td .d
LIST ALL OTHERS BELOW STATE L LICE SE NO. 4,01v (� C ASS -210
DISTRICT NO. GROUP ONE PR CES D B
/O
INSPECTION RECORD
a
O
U
Ir
O
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IU
n.
Plan-check fee. See reverse.
O .
PER.111T ISSUING FEE S 9-9
TOTAL. [FF: d
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING. AIR CONDITIONING. �`
I HEREBY •TIFY HAT 1 AM NO ACT NG IN VIOLATION ROUGH' U �• /5
OF CHAPTER 9AIVISIAP, OF THE BU ESS NO PROFESSIONAL �
CODE OF THE TATE LIFORNIA. FINAL
SIGNATURE .. PERMIT VALIDATION CK. M.O. CASH
OF PERMITT
PLAN CHECK VALIDATION CK. M.O. CASH
J. 6.2,--OCT 16 4 1 :U 3 4.5 0 A-%