HomeMy WebLinkAbout0 (4) 76A364C ICE-91991.9177 APPLICATION FOR PERMIT ,.' NJ
AIIEATING • VENTILATING - AIR CONDITIONING
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN !BUILDING JJ�J y
(PRINT OR TYPE ONLY) 'ADDRESS If�+�/.I ...A�/J• +�AU(� Y .i} '
1 LOCALITY -�CC,I.
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROSS ST.
ABSORPTION UNIT,BTU --1
OWNER 'L": "
AIR HANDLING UNIT.CFM MAIL
ADO RESS�-•I � �'V �� ^�
BOILER,BTU
CITY L.A.J��1. IJ�..(,,.1 �T.EL NO. , s•F!j)
COMPRESSOR,BTU ( l,�
CONTRACTOR
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER F.T
Y .��'�GL....T TEL.NO ^r
FURNACE: FAUGRAVITY TE ('�� /`'� LIC.FLOOR BTU ENSENO. '1 J /+'� CLASS
HEATER: SUSPENDED-UNIT_ DISTRICT NO, GROuP LINE PROCESSEDBY
WALL }
/ f! o
INSPECTION RECORD V
UA
..1
V_
c:
Plan check fee 25%of above.
PERMIT ISSUING FEE i`� 0
TOTALFEE
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PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NC
1 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING HEATING, VENTILATING, AIR
CONDITIONING.
1 HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OFAPPROVALS DATE INSPECTOR'S S IGNATURE
CHAPTER 9,DIVISIDN,3,.,QF T 'B,USINESS AND R0FESSIONAL CODE ROUGH
OF THE STATE OF CLIF HF
ORNfA'J ,
SIGNATURE �, T FINAL
OF PERMITTE
PLAN CHECK VALIDATION CA. M. CASH PERMIT VALIDATION CK. M.O. GSH
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