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76A364C
CE-818(REV.11/78)
®s APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITI NTNG
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COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING g
ADDRESS
(PRINT OR TYPE ONLY)
LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROSS ST.
ABSORPTION UNIT,BTU
OWNER IS AIR HANDLING UNIT,CFM MAILADDRESS �V�F
BOILER,BTU �I CITY -�,� TEL.NO.
COMPRESSOR,BTU rte/ VCPO /�N
CONTRACTOR ✓� P�^/
VENTILATION SYSTEM ADDRESS �C'T f?G A4 cast �L d
EVAPORATIVE COOLER CITY �� c e TEL.NO���-73$g
FURNACE: FAU GRA ITY STATE O LIC.
FLOOR BTU Od LICENSE NO. 302.5 CLASS 2 d
HEATER: SUSPENDED UNIT APPROVALS DATE INSPECTOR'S SIGNATURE
WALL
ROUGH
FINAL 0
u
INSPECTION RECORD ems9
0
Plan check fee 25%of above. wowo
PERMIT ISSUING FEEL
TOTAL FEE
PLAN CHECK APPLICANT PLi4N CHECK VALIDATION
NAME
ADDRESS'
CITY TEL.NO. $Q 7'4:A
I HEREBY THAT VHAVE READ THISSTATE THAT T ECDGE ABOVE EIS CORRECT AND AGR E TO COMPLY WIDTH AILL # 0 0 0 0 (�
ORDINANCES AND LAWS REGULATING HEATING, VENTILATING, AIR'
CONDITIONING. PERMIT VALIDATION 2 - 27.0-0
1 HEREBY CERTIFY THAT I AM NOT ACTI IN VI L T OF
CHAPTER 9, DIVISION 3, OF THE BUSIN AN ROFE CODE 'o o,o 2 TO 0 U
OF THE STATE OF
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SIGNATURE c/ 1 204-79
OF PERMITTEE
DISTRICT NO. PROCESSED BY
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