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Home My WebLink About0958 I� � 76A364C ICE-818 BI•11/76 • � . . . . • •^ .. - � ' � � � APPLICATION FOR PERMIT � • HEATING -,VENTILATIMG - AIR CONDITIONING� � � - . - , � , , . . ��''�`'"�:�... � BUILDING AND SAFETY�IVISION . . � ` FOR APPLICANT TO FILL IN eui��iN� ,. -, , IPRINT OR TYPE ONLY) - ADDRESS .Y.'... �'v. , �� ..�.�,: �Y C�5 s �.� 1 NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY '�j�r � �� .� ��„� � , � NEAREST • � � . � CR055 5T. ' ABSORPTION UNIT,BTU � . , ' OWNER �, � �� ..r,. r �.� . AIR HANDLIN6 UNIT,CFM MAIL � / ►'� ADDRE55 � !'.��'� � . ��I, t^r:�' ��r,. � ��; ; ' BOtLER.BTU l� y CITY"�� . � TEL.NO.��"t r ' � •�' r� n �, :� �`�.ti� . �.J I i..�'J� Y COMPRE550R,BTU ' CONTRACTO'i�Y, �, '�vf f p��,,, �r�,��^ � ' VENTILATIONSYSTEM � ADDRESS :� ��. Y!r �,f�� •,� EVAPORATIVE COOLER � GT�� ,.'.�� , �j., !�"; TEL.NO.� i'� c/ K; �: .v f�f �.r a FURNACE: FAU_GRAVITY � STATE P ,� + �!f� .,UC. r f^�"w,r � � f ' � FLOOR � BTU UCENSE NO.;�f. .;' � � r CLASS_ I r.� � HEATER: $USPENDED UNIT�— DISTRICTNO. GHOUP 10NE ;PROCESSED9Y WALL � / .� �'��:�.�-�r--- ��. �� . � . Q.�. .� INSPECTION RECORD� � �, ,.W.� � , iW � I . Plan check fee 25%of obove. .a �' PERMIT ISSUING FEE$ "'' -- ' `� O TOTAL FEE .?'�7 .--- '" � ;� PLAN CHEGK APpLICANT . ' ' �F� ^�'�� ` NAMG y. Y .. 1 'f. �.Y s� _ � f� i ' , '.� � ADDRES� ��,t � t 'k Sa w - � • � � CITY�� S �� P'. . � :) � TEL.�0.�:,� . �? •, �,;�„ . ' ' � : � I HEREBY RLKNOWLEDGE THAT I HAVE READ THIS APPUCATION AND � � ' � � � ' STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL � � . ORDINANCES AND LAWS REGULATING HEATING, VENTILATING, AIR ' . CONDITIONING. � I HEREBY CERiIFY THAT 1 AM NOT ACTING IN VIOLATION OF -APPROVALS DATE INSPELTOR'SSIGNATURE � �.� CHAPTER 9, �IVISION 3,OF TNE BUSI ESS AND PROFESSIONAL CODE � � OFTHES7ATE�Q CALIFORNIA.. � .�_,,-,.t,,._..,.,, ROUGH � �SiGNATURE��.`p��,, , �1� " � ''t �� FINAL OFPERMITTEF - - � ' � ' w PERMITVALIDATION cK. M.o. �c�sH : � PLAN CHECK VA jIDAT10N cK. rn.o. . usH ._ .. `� i , � " � ' , � t . � �a ,;t�*�'S� � ::1 ?�r� �1 '�a ,.. �'r� �J'c�E9'�' , _ . . :.., . � , �f . s