Los Angeles Fire Department
PERMIT
200 N. Main Street, 17th Floor, Los Angeles, CA 90012
Application for Specific Action Permit
Oil Wells
LOCATION INFORMATION Date of Use:
Name:
Date Granted
API: Multiple Use Dates
Address:
Date Expires: PERMIT# 6 Months from date Granted
Phone: State:
Zip Code
City
CONTRACTOR INFORMATION Name:
Phone:
Address: City:
State: Title:
Signature:
Print Name
Zip Code
PROPERTY OWNER / SPONSORING ORGANIZATION Phone:
Name: Address: City:
State:
Print Name:
Signatures:
Zip Code Titles:
** Do Not Write Below This Line ** Inspector Signature:
FIRE MARSHAL
Date:
Unit:
Oil Wells Unit
Permit will not be valid unless signed by Fire Marshal's
Phone#
(213) 978-3598
Billing and Accounts Receivable 16th Flr. Rm. 1620
ITEM
CODE
QTY
FEE
Abandonmnet/Re-Abandonment
388251
$3,610
Vent Cone
388217
$1,444
Fee Exempt
Total Fees:
For Inspector use only:
APPLIANCE TAGGED
FINALIZED INSPECTION shall be forwarded to: Fire Station
LR HR
Unit
NEW
Date of Finalization
EXIST
*Effective 10-10-2023