HomeMy WebLinkAbout0 (23) 7GA364C(CIE-Of 081.9/77 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
BUILDING AND SAFETY DIVISION
FOR.APPLICANTTO FILL IN r BUILDING / �^' LAr
(PRINT OR TYPE ONLY) .ADDRESS
(:1�1.•v y C4 �.
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY � ,y G
NEAREST
CROSS ST.
ABSORPTION UNIT,BTU
OWNER vL���;�.H "G i'1 J"( -L-__
AIR HANDLING UNIT.CFM MAIL
ADDRESS
BOILER,BTU CITYV - TEL.NO.
COMPRESSOR.BTU CONTRACTOR
VENTILATION SYSTEM 4ADDRIESS / ��CI C/(�. -�+�
EVAPORATIVE COOLER TY It �,t ` TEL.NO. e.(� 'r
FURNACE: FAU_GRAVITY STATE I ENSE NO. I .I�J ro CILA55 4- ?1
FLOOR BTU
HEATER: SUSPENDED _UNIT_ DISTRICTNO. GROUP ZONE PADCE55ED 0r
WALL ..lE JJ
t"I
INSPECTION RECORD - U
u
J
Lr ,
C
Plan check fee 25%of above.
PERMIT ISSUING FEE$ O
TOTAL FEE
PLAN CHECK APPLICANT
NAME.
ADDRESS
CITY TEL.NO. i
IHEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION AND
STATETHAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING HEATING, VENTILATING, AIR
CONDITIONING.
I 1 HEREBY CERTIFY THAT 1 AM NOT ACTING IN VIOLATION OF APPROVALS DATE INSPECTORS StGNATVRE
(,CHAPTER 9.DIVISION 3.OF THE BUS NESS Ay'D PI}O FISSIONAL CODE
!OF THE STATE OF CALIFORNIA. ROUGH
SpIGNAT RE
FPERMITTEP �"� FINAL
PERMIT VALIDATION CK. ra.O. cnsN
PLAN CHECK VALIDATION C� MD. CASR
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