HomeMy WebLinkAbout0 76A364C ICE-91991.9177 APPLICATION FOR PERMIT
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•
1 LOCALITY -`C;,�,.-.�Y(.� ->G''•"�,
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROSS ST.
ABSORPTION UNIT,BTU --I
OWNER \..C�"
AIR HANDLING UNIT.CFM MAIL
ADO RESS�-•I � �'V �N ^�
BOILER,BTU
CITY ��n.J7�y I!.�'..C`.l �T.EL NO. , s•F!D
COMPRESSOR,BTU ( l,�
CONTRACTOR
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER F.T
Y .�\I(�L..,,T TEL.NO ^r
FURNACE: FAUGRAVITY TE ('�� /`'� LIC.FLOOR BTU ENSENO. '1 J /+'� CLASS
IC
HEATER: SUSPENDED-UNIT_ DISTRICT NO, G"OuP LINE PROCESSEDBY
WALL }
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INSPECTION RECORD V
UA
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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,..p.F THF'BUSINESS AND R0FESSIONAL CODE ROUGH
OF THE STATE OF CLIF ORNRI �• ,
SIGNATURE ; �, T I»� FINAL
OF PERMITTE
PLAN CHECK VALIDATION CA. M. CASH PERMIT VALIDATION cA. M.D. CASH
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