HomeMy WebLinkAbout0 (30) 7GA364CICE.eleal:oin APPLICATION FOR PERMIT v'
HEATING - VENTILATING - AIR CONDITIONING
BUILDING AND SAFETY DIVISION.
FOR APPLICANT TO FILL INBUILDING �Y
ADDRESS
(PRINT OR TYPE ONLY! //
LOCALITY -:%�i�rj��V✓ >f,X,✓
NO. TYPE OF APPLIANCE OR EOU IPM ENT ,FEE NEAREST
j CROSS ST.
ABSORPTION UNIT,BTU
OWNER JC.-%Y LJ
AIR HANDLING UNIT,CFM MAIL
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BOILER.BTU �// ?'
CITY 'r�Vf�I��f���� !✓.'��� EL.NO.
COMPRESSOR,BTU
CONTRACTOR( J � ''�/(/ �_/��i.� //✓�
VENTILATION SYSTEM ADDRESS /
EVAPORATIVE COOLER CITY STATE ''TT TEL.NO.
FURNACE: FAV,_GRAVITY LICENSE NO. /�%'T/c/) CLASS
FLOOR BTU
1 EATER: SUSPENDED—UNIT_ DISTNICTND. GROUv 2ONE PROCESSED BY
t .WALL /', J7—.
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INSPECTION RECORD V
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Plan check fee 25%of above. g
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PERMIT ISSUING FEE$ a
TOTAL FEE
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PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO.
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND
I,STATE THAT THE ABOVE IS CORRECT AND AGREE 70 COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING HEATING, VENTILATING. AIR
CONDITIONING.
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF APPROVALS DATE INSPECTOR'S SIGNATURE
LEHAP7ER 9,DIVISION 3.OF THE BUSINESS AND PROFESSIONAL CODE
OF THE STATE OF CALIFORNIA- ROUGH
51C N ATURE //' "
OF PERMITTEE / �'�� l.I[l-"-(� FINAL
PLAN CHECK VALIDATIONcA. M:D. cash PERMIT VALIDATION c, H.o. CASH
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