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CE-818 jREV.11/78)
m: APPLICATION FOR PERMIT ;
HEATING - VENTILATING - AIR CONDITIONING i
COUNTY OF LOS ANGELES BUILDING AND SAFETY �
_ �
FOR APPLIGANTTO FILL IN gui�oi :
IPRINT OR TYPE ONLYI ADDRE S � ���
LOCALITY �
NO. TYPE OF APPLIANGE OR E�UIPMENT FEE
NEAREST
CR055 ST.
ABSORPTION UNIT,BTU
OWNER
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AIR HANDLING UNIT,CFM MAIL
ADDRE
BOILER,BTU CtTY TEL.M
COMPRESSOR,BTU CONTRACTO
VENTILATION SYSTEM ADDRE55
EVAPORATIVE GOOLER CITY TEL.N
FURNACE: FAU GRAVITY STATE LI . ! �
FLOOR BTU LiCENSE N . � CL;AS �� O
HEATER: SUSPENDED UNIT� APPROVALS DATE IN ECT SSIGNATUNE V
W A ' �r
ROUGH r` ! : • " '; � O
FfNAL � �'"��f=':�� �
.`F :�r.�.: W
INSPECTION R G�� ��y
^�A' i4
Plan check fee 25°io of above. '
PERMIT f55U{NG FEE� Q �
TOTAL FEE
PLAN CHECK APPLICANT pLAN CHECK VALIDATION
NAME
r 11' �1 �'
ADDRESS `- � �`'
GITY TEL.NO. �� � � � � L �
I MEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND � I • '� 1 �.C C
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING HEATING, VENTILATING, AIR ro „ r.? C� i S
CONDITIONING. � �' ' ^� �'`'
PERMIT VALIDATION
1 HEREBY CERTIFV THAT I AM NOT ACTING IN VIOLATION OF • '� r?i
CHAPTER 9. DIVISION 3. OF E BUSINE55 AND PROF SSIONAL DE i: r'�: ' F` G
OF THE STATE OF Af IF
SIGNATURE
OF PERMITT
DISTRICT NO. PROCESSE�8Y
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