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76A364CICE-8I8131-9in APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
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13UILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUILDING I(? v
(PRINT OR TYPE ONLY)
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY }•/�r�y'.Y�,��_ - IS�V`�
NEAREST
CROSS ST.
ABSORPTION UNIT,BTU / .-
OWNER .,�C`�-�tk
AIR HANDLING UNIT,CFM MAILt\`I'
ADDRESS -�(J , .'/ )
BOILER,BTU CITY �7 „I, - J' (� •27cJ
A ` TEL.NO. /
COMPRESSOR.BTU CONTRACTOR (• (11-lfiv, I
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CITY ` - TEL.NO.�
FURNACE: FAU-GRAVITY LICENSE N �' ( /V CLASS 1
FLOOR BTU
HEATER: SUSPENDED_UNIT_ DISTRICTNO. GROUP ZONE 7 PROCESGEODY
i WALL ':;v�' L•'C. .f
0
INSPECTION RECORD LuV
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Plan check fee 25%of above.
1 PERMIT ISSUING FEE s r / a
TOTAL FEE ^ � ^
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANDS,
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING HEATING. VENTILATING, AIR
CONDITIONING.
I HEREBY CERTIFY THAT I AM NOT ACTING VIOLATION OF APPROVALS DATE INSPECTOR'S SIGNATURE
CHAOTER 9.DIVISION OF THE BUSINESS AND P O"SS1ONAL CODE ROUGH
OF THE STATE OF CALIF RNIA / A
SIGNATURE J J !"e / FINAL
' OF PERMITTEE / �-
PLAN CHECK VALIDATION CK. M.O. :ASH PERMIT VALIDATION C, MD. CASH
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