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APPLICATION FOR PERMIT
IDEATING - VENTILATING - AIR CONDITIONING
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BuNNG
(PRINT OR TYPE ONLY) ADDRESS 5133 N. Arden Dr.
LOCALITY Temple City
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST
CROSS ST. Freer
ABSORPTION UNIT, BTU
OWNER
AIR HANDLING UNIT, CFM MAIL
ADDRESSFf}-
BOILER, BTU CITY TEL. NO.4, "'L-�0�
COMPRESSOR, BTU, :36 C► O 111
-TCONTRACTOR Air-Dyne s (lo jW
VENTILATION SYSTEM ADDRESS_555 "o if Com--
EVAPORATIVE COOLER CITY !fK TEL. NO.d.3o -77001
FURNACE: FAU GR VITY STATE // // LIC.
FLOOR BTU ) LICENSE NO. Cp6-3 CLASS �D
HEATER: SUSPENDED UNIT_ DISTRICT NO, GROUPZONE PRO SED BY
WALL �
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INSPO
ECTIN RECO w
a
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Plan check fee 25% of above.
PERMIT ISSUING FEE $
LL�ITOTAL FEE
PLAN CHECK APPLICANT
NAME
R! ADDRESS
a CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
' AND STATE THAT THE'ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALLORDINANCES AND LAWS REGULATING HEATING, VENTi-
LATING, AIR CONDITIONING.
I HEREBY CERTIFY THAT i AM NO ACTI N VIOLATION APPROVALS DATE INSP/E.FTOR'S SIGNATURE
OF CHAPTER 9, DTVISION3, F THE B N SS RO FESSIONAL V
CODE OF THE STATE OF IFORNIA. ROUGH �3•' �
SIGNATURE �7
OF PERMITTEE _ FINAL 7
PLAN CHECK VALIDATION CK. M. , CASH PERMIT VALIDATION CK M.0. CASH
6:5 4,;iAUG ,l j .4 1- u 1 y.5