HomeMy WebLinkAbout1504•r
7SA3.G.c ICE -61e Mi-nnb APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
BUILDING AND
SAFETY DIVISION
FOR APPLICANT TO FILL INBUILDING
(PRINT OR TYPE ONLY)
ADDRESS
LOCALITY
I HEREBY ACKNOWLEDG ATI AVE REA THIS APPLICATION AND
NO.
TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROS55T.
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ORDINANCES AND LAWS RECD INC ATI G. VENTILATING, AIR
ABSORPTION UNIT. BTU CSC/ O
--
OWNER d
K.
HEREBY C FY AT I AM N T ING IN VIOLATION OF
AIR HANDLING UNIT, CFM
MAIL
ADDRESS
SIGNATURE t
FINAL
-'
BOILER, BTU
PERMIT VALIDATION cR.
CITY
COMPRESSOR, BTU
CONTR TO
VENTILATION SYSTEM ADORE
EVAPORATIVE COOLER CITY
FURNACE; FAU_GRAVITY STATE
FLOOR BTU LICENSE NO.
HEATER: SUSPENDED ---UNIT_ OlsralcT NO.
WALL ID
Plan check fee 25% of above.
PERMIT ISSUING FEE pp
TOTAL FEE_ 7 Z
PLAN CHECK APPLICANT
NAME-_ -----..
ADDRESS
TEL.
EL. NO.
7 LIC.
CLA
m. 1r
INSPECTION RECORD
M
ca /504 42178 41 27.00#
bs
CITY TEL. NO.
I HEREBY ACKNOWLEDG ATI AVE REA THIS APPLICATION AND
STATE THAT THE ABOVE 1 ORREC AND A TO COMPLY WITH ALL
ORDINANCES AND LAWS RECD INC ATI G. VENTILATING, AIR
CONDITIONING.
APPROVAL5 o E
INSPECT R' IRNAT
HEREBY C FY AT I AM N T ING IN VIOLATION OF
CHAPTER DIV OF BUSIN D PRO SSI DE
OFTHE STATE IFORNI
-
ROUGH
SIGNATURE t
FINAL
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-p-AN CHECK VALIDATION CN' M.a. cAss
PERMIT VALIDATION cR.
N.0 casR
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