HomeMy WebLinkAbout0917A i . . �
76A364C
CE-818(REV.11/781
c�:. APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF l05 ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING v /T,e ,--�t
(PRINT ORTYPE ONIYI ADDRESS (� 1..�
� LOCALITY ' �
NO. TYPE OF APPIIANGE OR EQUIPMEN7 FEE
NEAREST
CROSS ST.
ABSORPTION UNIT,BTU �
OWNER �
• �v
AIR HANDLING UNIT,CFM MAIL
ADDRE55 �� � �
BOILER,BTU � f C,
, � �� � CITY (Cs'6'z,*tv���a�Lj EL.NO���I4+liG�
J
COMPRESSOR,BTU CONTRACTOR ^q�
VENTILATION SYSTEM AODRE55
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EVAPORATIVE COOLER � ���� GTY TEL.NO.
FURNACE: FA �GRAVIT 1y ,,�.)e STATE � �y �IC. "A�
� FLOOR BTU V �^`4 LiCENSE NO. 4 / p� CLASS �"
.�
HEATER: SUSPENDED UN1T_ pppROVA�S Da'tE INSPECTOR'SSIGNATURE w
WALL �m
ROUGH y
7 ^f F
F I N A L t�./ ;,�! .:.�"�,C. �Z� ~ r RJ
INSPEC ION RECORD �
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Plan check fee 25°% of above.
PERMIT ISSUING FEE$ (}'�?
TOTAL FEE � d'L
PLAN CHECK APPIICANT PLAN GHEGK VALIDATION
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY'N,'ITH AL�
ORDINANCES AND LAWS REGULATING HEF?WG, VEN711.A71NG, AIR
coN�inoNirvc. PERMIT VALIDA710N �Q�J �,%A
I HEREBY CERTIFY THAT ! AM NOT ACTING IN VIOLATION OF
CHAPTER 9, DI'JISION 3, OF THE B1151NE5 AND PROFESSIONAL COD'c p � � � � /� 1
OF THE STATE OF CALIFORNIA. � V' �
SIGNATURE (' �7 (�
OF PERMITTEE � �'ys'�� � ,0 � y. 1,�,J�,i
DISTRICT NO. PROC SSED 9 q w • /i "! ���
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