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76#364 - CE%IB - 3-69 .. APPLICATION FOR PERM T
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING +
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION
JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY
COLEMAN W.JENKINS,SUPERINTENDENT OF BUILDING NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN
(PRINT OR TYPE ONLY) OW NE _Cl
MAIL y
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
ABSORPTION SYSTEM, BTU CITY TEL. NO. � /
AIR HANDLING UNIT, CFM CONTRACTOR
BOILER; HORSEPOWER ADDRESS
CITY TEL. N0.
COMPRESSOR, HORSEPOWERSTATE LIC.
p
LICENSE NO. CLASSD
VENTILATION SYSTEM DSTATISTRICT NO. GROUP /ZONE PROCESSED BY
EVAPORATIVE COOLER :r I
FURNACE: FAU A6 G VITY 1
FLOOR BTU INSPECTION RECORD
HEATER: SUSPENDED UNIT
WALL
a
C
0
F
L
u
NEWADDITION_Lp
ERMIT $ 3 00
ALTEREPAIR_ OTAL FEE $
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
IHEREBY 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 TE ECTOR' IGNATURE
VENTI-
LATING,A-IR CONDITIONING.
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH
CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL
CODE OF T OF C IFOR IA. 7O
SIGNATUR JACK R. ALLEN, SUPERV MECHANICAL ENG'R.
OF PERMI EE PERMIT VALIDATION cK. M.O. CASH
PLAN CHECK VALIDATION
f Aro 4 2 2 89 MAR 25 4 1 D 7.01&_
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE ��MLJ