HomeMy WebLinkAbout0 (22) 76A]BA C ICE(:5IBE+).9/TT APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN ILIVILUiNG
(PRINT OR TYPE ONLY) ADDRESS
LOCALITY !r `G%')G.� !'•�
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROSS ST.
ABSORPTION UNIT,BTU
AIR HANDLING UNIT,CFM MAIL
ADDRESS II219/
BOILER.BTU CITY J"% `{ //EL.NO.
COMPRESSOR.BTU /
CONTRACTOR liL��r
VENTILATION SYSTEM
ADDRESS j�'J-.i i' �✓ /;��'J. J/
EVAPORATIVE COOLER CITY �:%f :,' TEL.NO.(j.''�/FURNA /�' �.
FLOOR CE: FAU BTUGRAVITY STALICENSE NO. 1 {'/(/ CLASS`
HATER: SUSPENDED-UNIT- • `,�r.. 1 DISTPICTNO. - GROUP ION! PROCESSED BY
1�,..�..�VVALL F. r. _..__ Y
0.
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INSPECTION RECORD j
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Plan check fee 25%of above.
PERMIT ISSUING FEE$ _ f•f 0
TOTAL FEE yfj e-- j
PAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO. -
I HEREBY ACKNOWLEDGE THAT I 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.
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF APPROVALS DATE INSPECTOR'S SIGNATURE
CHAPTER 9.DIVISION 3,OF THE BUSINESS AND PROFESSIONAL CODE ROUGH
OF THE STATE OF C/pLIFO NIA J
SIGNATVRE �L// !' 1r ._�/%�''/f FINAL
OF PERMITTEDtY-
PLAN CHECK VALIDATIONr cK. M.o. CASH PERMIT VALIDATION CK. M.O. [ASH
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