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76A354C
CE-BIB(REV.11/7g)
�Y+ APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUIIDING AND SAFETY
FOR APPLICANT TO FILL IN DUILDING ��OS2. J ST '✓�
IPRI\7 OR TYPE O�LYI ADDRE55
NO. TYF'E OF APPLIANCE OR EQUIPMENT FEE LOCALITY ��n�,,.VQ ✓ �
NEAREST
CROSS ST.
AOSOF2PTION UNIT,BTU )
OWNER � L � J l.��V/J
AIR HANDLING UNIT,CFhi M17AIL
ADDRE55 IZ'i Q
EIOILER.OTU GITY TEL.NO.S y✓G�^,
COh7PRE550R.DTU COYTRACTOR
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VENTILATION SYSTEM ADDRESS S' 1 �
EVAPORATIVE GOOLCR GITY TEL.NO.
FURNACE: FAU GRAVITY STATE LIG. a
FLOOR �TU LICEhSE NO CLA55 O
HEATER: SUSPENDED UNIT�� APiItOVAlS D�iC I".SPECTOp'SSIGtATLFC V
6V ALL
OC
Ml ROUGH
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FINAL Q � �' W
INSPECTION RECORD a
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Plan check fee 25%of obove.
PERMIT ISSUING FEE� (J7J
TOTAL FEE
PLANCHECKAPPLIGANT PLAN CHECK VALIDATION .
NAM7E '
ADDRE55
CITY TEL.NO.
I HERE6Y AGKV015'LEDGE TMAT I HAYE FEA�THIS APPLICATIOti AtiD
STATE THAT TMIE ADOVE IS CORRECT AhD AGaEE TO COA'P�Y YlITFi ALL
ORDIVANCES A�D LAWS REGULATIVG FiEATI�G. VE�TILAiI+:�, AIR
con�iTion�tic. PERMIT VALIDATION C p
1 HEREBY GERTIFY THAT I AS1 KOT ACTIM1G IN VIOLATION OF %O �9.[:'II
CfIAPTER 9. DIVI5104 3, E 8:151hE55 A�D PItOFESSIO,tiAL CO�: � ,
OF TH[STATE OF CALIF NI. �.' • •�• • [�,1
SIGNATL'RE /� J �
OF PERMIT7E � � • • � �G G
D157HICT NO PNOCESSLD � ,� O O L:
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