HomeMy WebLinkAbout0 (25) 76A]BA C ICE(:5IBE+).9M APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
BUILDING AND SAFETY DIVISION
FOR APPLICANTTO FILL IN ILIVILUiNG
(PRINT OR TYPE ONLY) ADDRESS
LOCALITY fir' ` %')G./ /•-� w
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROSS ST.
ABSORPTION UNIT,BTU
OWNER,.JC�-1////V--((--// ,/
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AIR HANDLING UNIT,CFM MAIL
ADDRESS /��J1� Lam/ '����j.�. _� /lam 0
BOILER.BTU CITY J"%
COMPRESSOR.BTU /
CONTRACTOR liL��r
VENTILATION SYSTEM
ADDRESS/r�'J-.i i' �✓ /;��'J. J'
EVAPORATIVE COOLER CITY TEL.NO.(/':'/FURNA
FLOOR CE: FAU BTUGRAVITY STAL GETNSE NO. l {'/(/. CLASS -..)
III
HATER: SUSPENDED-UNIT- GPOUP 0 ICNE PROCESSED BY
I.�'•.�..�WALL F. r.
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INSPECTION RECORD vj
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Plan check fee 25%of above.
PERMIT ISSUING FEE$ _ f•f o0.
TOTAL FEE --� j
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY _ TEL NO. -
IHEREBY 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.D. CASH PERMIT VALIDATION CK. M.O. CASH
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