HomeMy WebLinkAbout0 (27) 7GA364C ICE•81ED):9/77 APPLICATION FOR PERMIT v'
HEATING - VENTILATING - AIR CONDITIONING
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN I
UILUING �Y
(PRINT OR TYPE ONLY!
DDREOCALITYND. TYPE OF APPLIANCE OR EOU IPM ENT FEEAREST
ROSS ST.
ABSORPTION UNIT,BTU / /1` 'WNER J1%Y 'f.lfV LJ lr _AIR HANDLING UNIT,CFM AIL f' /
ADDRESS-/12(
BOILER.BTU
CITY 'r Vf�I f�Il�� !✓.'�� EL.NO. �.:�;.: i I.V
COMPRESSOR,BTU
CONTRACTOR( ' /(/ =L( .� ,//✓�
VENTILATION SYSTEM ADDRESS /
EVAPORATIVE COOLER CITY 'T TEL.NO.���-J��(%
FURNACE: FAUN_GRAVITY LSTATELICENSE NO. / 'T �. CLA55 ( �'
FLOOR BTU
^7 EATER: SUSPENDED-UNIT_ DISTRICT ND. GROUP TONE PROCESSED BY
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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 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
LEHAP7ER B,DIVISION 3.OF THE BUSINESS AND PROFESSIONAL CODE
OF THE STATE OF CALIFORNIA.,, ROUGH
SIGNATURE //' �'' FINAL
OF PERMITTEE / �'�� l.I[l-"-(�
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION C, M.D. CASH
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