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CE-818(REV.11/78)
o� APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING �.� /p `�..
ADDRE55 N�� ,C,�f�i (�
(PRINT OR TYPE ONLY) /�
LOCALITY �I�'ma"•I VJ j';/"Q��
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE '�` �
C J GROSS ST. �/7T�Fi//�✓�`
ABSORPTION UNIT,BTU ���/ �� v ` �,,p
OWNER m� ��{C Gd/C.�"'
AIR HANDLING UNIT,CFM MAiL ,���r ��
AD�RE55
BOILER.BTU CtTY �� � TEL.NO.
COMPRESSOR,BTU CONTRAGTOR�p�►���nq� ���Sh�
VENTILATION SYSTEM ADDRE55 f � ����
EVAPORATIVE GOOLER u��,��� , TEL.NO. ����� �
G ETY
FURNAGE: FAU GRAVITY STATE n` LIC. � �"'
FLOOR BTU LICENSE NO. wW v 3� CLq5S 2 d (
HEATER: SUSPENDED UNIT� qpppDYALS � DATE r IN �,C R'SSIGN URE � V `
W ALL
ROU6H � �
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. FINAL � G
W
INS ECORD �
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Plan check fee 25%of above.
PERMIT ISSUING FEE� QU
'COTAI FEE � r�
PLAN CHECK APPLICANT pLAN CHEGK VALIDATION
NAME
ADDRESS
� P� _ ��. �., F�
CITY TEL.NO.
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND '� � . �
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING HEATING. VENTILATING, AIR �� • • .:. �: ;�� �..
coNoiriorviNc. PERMIT VALIDATION : -
I HEREBY CERTIFY T T I AM NOT ACTIN VIOLpTION OF �'" � '� • -
CHAPTER 9, DIVISION 3 THE ND FESSIONAL CODE
OF THE STATE OF C LI ,. ,� ; i: -,. ,. �
SIGNATURE
OF PERMITTF�E
DISTRICTNO. PROGESSED
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