HomeMy WebLinkAbout0 (25) 7GA084C ICE-Of BE) 9/77 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
BUILDING AND SAFETY DIVISION
FOR APPLICANTTO FILL IN BUILDING
(PRINT OR TYPE ONLY) ADORE SS
LOCALITY i ,L C:I�I�.v y G
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROSS ST.
ABSORPTION UNIT,BTU
OWNER
AIR HANDLING UNIT.CFM MAIL
ADDRESS
BOILER.BTU CITYG TEL.NO.
COMPRESSOR.BTU CONTRACTOR 7 L � I,-f', J
VENTILATION SYSTEM DDRESS -�+�
EVAPORATIVE COOLER TY ��I ,,t �,t STATE ` TEL.NO.',1 V 'e. r W
FURNACE: FAU_GRAVITY E NO. I .I�J r� CILA55 4—
?1
FLOOR BTU
HEATER: SUSPENDED _UNIT_ DISTRICTNO. GROUP zONE PROCESSED BY
WALL F�JCENS
INSPECTION RECORD - U
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Plan check fee 25%of above.
PERMIT ISSUING FEE$
TOTAL FEE ? - m
r-
PLAN CHECK APPLICANT
NAME.
ADDRESS
CITY TEL.NO. i
IHEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION AND
STATETHAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING HEATING, VENTILATING, AIR
CONDITIONING.
1 1 HEREBY CERTIFY THAT 1 AM NOT ACTING IN VIOLATION OF APPROVALS DATE INSPECTORS StGNATVRE
,CHAPTER FTH 9.DIVISION 3.OF=BUSES PI}OFESSIONAL CODE
$ THE STATE OF CALIFORNIAJ 1 ROUGH
SpFPERMITTIGNATU F"EP _\�/'�"� FINAL
PLAN CHECK VALIDATION CR. M.O. CASK PERMIT VALIDATION CK. M.O. CASH
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