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76A364C
CE-618 IREV.6/781
;�,5 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDIiIONING
,. �, COUNTY_QFlOS AIyG�4�5...:: . .:•:..:... ...........w_BUILDING AND SAFETY
FOR APPLIC�NT TO FILL!N BUILDING > w�.e� �y�
i,�. . .
IPRINT OR TYPE ONLY) AD SS
LO ITY �� � '3^ <
NO. TYPE OF APFLIRNCE OR EQUIPMENT FEE �
NEAREST
CRO55 ST. �
A.B.$ORPTIQN.UNIT,BTU
OWNER 1� e,a -��
AIR NANDLIN,G UNIT,CFM MAIL �
ADDRESS �� �
801LER,BTU �
CITY � TEL.N��C'„��C�f '�l
. J y_
COMPRESSOR,BTU � IQ F C�� GONTRAGTO �n'�_/�i� � f� �J�
iL �� T
VENTILATION SYSTEM . qDDRESS �,y, ' ���� � �
Ca-W �
EVAPORATIVECOOLER CITY �� /� `C'� TEL.IV�`•�'���
FURNACE: FAU__GRAVITY STATE +� LIC.
FLOOR BTU LICENSE NO. �•�S�" "� CLA55 + i.Z�
HEATER: SUSPEN�ED UNIT� ApPpovq�s. �a7e �NSPeeroR�sscn•a1uRe
WALL "
ROUGH
�
FINAL. �
" """"' INSPECTION REGORD �
�
,, 1 � � � , � lL�
PI;Qn check fe.e 25%of above. `^ ` �
PERMIT,ISSUING FEE� � Q� " �
TOTAL FEE /7 �a � �
PLAJy CHECK APP{.lGANT p�,qN CHECK VALIDATION
r.�..,
� NAM,�.
?4DRE5,5. „ ,
,,,Y.., TEL.NO.
I H�REBY ACKNOWLE�GE TNAT I HAVE READ THIS APPLICATION AND
STATE THAT 7HE ABOVE IS CORRECT AND AGREE TO COMPLY'JJI7H ALL
ORDINANCES AND LA'JJS P.EGULATING .HEATING, VENTILATIVG, AIR
40NDfrioNinc. PERMIT VALIDATION =' 1 7/,,2 �
I HEREBY CERTIFY THAT I AM NDT ACTING.IN VIOLATION OF ���� �
�HAPTER 9, DIVISIDN 3, OF THE BUSINE55 AND PROFESSIO�AL CODE �:
OF THE STATE OF CALIFORNIA. ,,/ 'i"' ° m �' d G.y �
SIG�+ATI:RE y �7
OF PERMIT7E� � �' � 9 1�l/O
DISTRICT K0. PROCESSED BY .
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