HomeMy Public PortalAbout5128 AGNES AVE_Mechanical_7/26/1976_ 76A384E CE818l,B e/75 APPLICATION FOR P IT
HEATING - VENTILATING - AIR CONDITIONING
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BUILDING AND SAFETY DIVISION °
FOR APPLICANT TO FILL IN BUILDING
(PRINT OR TYPE ONLY) ADDRESS &Sv,—
LOCALITY
NO TYPE OFAPPLIANCEOR EQUIPMENT FEE NEAREST
CROSS ST
ABSORPTION UNIT BTU
OWNER
AIR HANDLING UNIT CFM MAIL
ADDRESS es
BOILER BTU
p N CITY TEL NO
COMPRESSOR BTUSV
CONTRACTOR
VENTILATION SYSTEM ADDRESS
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EVAPORATIVE COOLER I
CITYJEL NO ,c
FURNACE FAU_GRAVITY TATE LIC
FLOOR BTU /b,57- LICENSE NO CLASS
HEATER SUSPENDED UNIT_ Y DISTRICT NO GROUP ONE /PROCSSED BY �-
' WALL V
C)
t INSPECTION RECORD v
W
Cn
N
r Z
Plan check fee 25% of above L
PERMIT ISSUING FEE $
TOTAL FEE 3
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO
I HEREBY 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 VENTI
LATING AIR CONDITIONING
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION APPROVALS DATE INSPECTOR S SIGNATURE
OF CHAPTER 9 DIVISION 3 OF THE BUSINESS Ap Pp ESSIONAL
CODE OF THE STATE OF CA A ROUGH
SIGNATURE q ..
OF PERMITTEE FINAL f
PLAN CHECK VALIDATIONCK M 0 CASH PERMIT VALIDATION cK M o CASH -
23.25
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