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76A364CICE=8I813I-9in APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
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13UILDING AND SAFETY DIVISION 'i.
FOR APPLICANT TO FILL IN BUILDING }
(PRINT OR TYPE ONLY) AOO RESS /�? `,;(... "a: V
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY
NEAREST ,
CROSS ST.
ABSORPTION UNIT,BTU /
OWNER
AIR HANDLING UNIT,CFM MAILt\`I'
ADDRESS -�(J , .'/ )
BOILER,BTU CITY �7 „I., C, - J' (� •27cJ
A ` TEL.NO. /
COMPRESSOR.BTU CONTRACTOR ( (11- I
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CITY ` - TEL.NO.�
FURNACE: FAU-GRAVITY LICENSE N �' ( /V r CLASS 1
FLOOR BTU
HEATER: SUSPENDED_UNIT_ DISTRICTNO. GROUP ZONE 7 PROCESGEODY
i WALL ':;v�' L•'C. .f
0
INSPECTION RECORD V
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Plan check fee 25%of above.
1 PERMIT ISSUING FEE r / a
TOTAL FEE ^r
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANDS, li
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
CHAPTER 9.DIVISION OF THE BUSINESS AND P O"SS1ONAL CODE ROUGH
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OF THE STATE OF CALIF RNIA / 1
SIGNATURE Jj "e ) _ / FINAL
' OF PERMITTEE / � -
PLAN CHECK VALIDATION CN. M.O. :ASH PERMIT VALIDATION C, CASH
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