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76A364C
CE - BIB (REV. 11 / 78 )
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN
PRINT OR TYPE ONLY)
BUILDING
ADDRESS 1
LOCALITY
OWNEN.Sk
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROSS ST.
ABSORPTION UNIT, STU
AIR HANDLING UNIT, CFM I MAIL if
ADDRESS (
BOILER. 8TU O Q CITY EL. NO.
COMPRESSOR, BTU CONTRACT
VENTILATION SYSTEM
ADDRESS
EVAPORATIVE COOLER CIT TEL. NO
STATELIC /J
LICENSE NO. C
APPROVALS D E PEciO SIGNAruaE
FURNACE: FAU GRAV
FLOOR TU
HEATER: SUSPENDED UNIT_
WALL
Q `/
ROUGH
FINAL
IN EC ION RECORD
Plan check fee 25% of above.
PERMIT ISSUING FEE $ 00
TOTAL FEE
PLAN CHECK APPLICANT PLAN CHECK VALIDATION
7 6 n 2 A
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1
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PERMIT VALIDATION N a r 2 7 0 0
2 7. 0 0 E
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NAME
ADDRESS
CITY TEL NO.
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO LY WITH ALL
ORDINANCES AND LAWS REGULATING HEATIN VENTILATING. AIR
CONDITIONING.
1 HEREBY CERTIFY THAT AM NOT A TING INXIOLATIO OF
CHAPTER 9. DIVISION 3. OF E BUSINESS A P OFESSIGNALyll
OF THE STATE OF CALIF R
OF
PERMIRE
DISTRICT NO. PROCESSED BY
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