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HomeMy WebLinkAbout1445A i _ _ 76A364C CE-818(REV.l l i 78) �� APPLICAT101� FOR PERMIT HEATING - VENTILATBNG - AIR C�FiD(TIONING COUNTY OF LOS ANGELES BUILDING AND SAFETY - .. : y.... . P. �;1. BUILDING �.. .... � . ;:>,. ,, FOR APPLICAiVT`8'd �IGL'IN_ �"'` ' ' � (PRiNT OR TYPE ONLYI � ADDRESS �.� � - � LOGALI7Y - � � NO. TYPE OF APPLIANCE OR EQUIPMENT FEE - . � NEAREST - .. . � . . .. . . � . . , . CRpSS ST. ABSORPTION UNIT,BTU� � � �� � . �� � �� . � � . . . OWNER �+��e.� ��w AtR HANDLING�UNIT,CFM� Mq�� ��- ' - � .- . � �. � - � � ADDRE5S � _ BOILER,BTU _ � Ci7Y � TEL.N �r . � - CpMPRE550R,BTU CONTRACTOR �, �� � -���� � , VENTILA710N SYSTEM I ADDRESS � EVAPORATIVE COOLER CITY TEL.N . ~ awa .. FLOORCE: - FAU BTU G��VITY- . .. . �C NSE NO. .A.L�tl�� C A55 eaw"*"«,7�«8 .,' HEATER.' SUSPENQED_._.UNIT_...V APPROVALS - DATE"�� INS�Y+ECTOR'S�SIGNATURE�"� WAIL ���� ROUGH �,r FINAL INSPECTION RECORD �.Pl�an check fee 25%of above. PERMIt 155UING FEE$ '" >, TC)TAL FE� _� PI.AN CHECK APPUCAN7 PI.AN CI"I�CK!/AL.IDATION NAME - � �. � -� . ... . . . - . ...: .fADDftESS y��,'���?�� ��{An��� A;������� t,d�`i+w .. � p . -C11�Y ���.�'7�F'����� � TEL.�N�O�Tw�"n.r��„�;f . . 1 � 4a'�i� ,��. � I HfiREBY ACKNOWLEDGE THAT I HAVE READ TFIS APPCICA710N-AN� � �+�' � �4� Y'�l� ��� - -�STA7E THAT�THE ABOVE IS CORREC7 AND AGREE TO CON�PLY WITH ALL� � � � 4'. �, � ,,� � � '-�pR'IS�INA�CES��AND�LAWS REGU'�_ATING HEATING, VEN71L'ATING�, AIR - µ . � ��; �CONT1l710�NINf;. . ���. . . . � � F- � �:�'�,.. � PERMIT VAI...IDA710N �i- I M�REBY CERTIFY THAT I AM NOT ACTWG IN VIOLATION OF . - - � � �! '�' '����4���;p �;���CHAp7'CR'9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL CODE � ' � ' - � ���OF THE�5TATE OF CALIFORNIA. � � � � , �,,t,}���i��.�� a: -SIGNA7URE � .. �, yk,H;n„'.:x"x'`"++�,, . ��` �'b.F�E f$,MfTi(£F_ " �.+t�.�... � '..'dIST,RICY'Np.- ' . . . " . . . PROCESSED`BV . .. . .. .. .,t".� . . . - . . � . 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