HomeMy Public PortalAbout4410TEMPLE CITY BLVD_Mechanical TEAM!E ICE' e1eAI 1In6 APPLICATION FOR PERMIT
HEATING - VENTILATING - kR CONDITIONING
OF LOS AN 5
DEPA ENT OF COUNT NGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUILDING �p
(PRINT OR TYPE ONLY) ADDRESS I'll
LOCALITY
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROSS ST
ABSORPTION UNIT BTU
OWNER
AIR HANDLING UNIT CFM MAIL '
ADDRESS
BOILER BTU CITY TEL NO
COMPRESSOR BTU CONTRACT
VENTILATION SYSTEM ADDRESS D�
EVAPORATIVE COOLER CITY TEL NO
c /
FURNACE FAU_GRAVITY STATE
FLOOR BTU LICENSE NO� 3.26 C ASS G A+.O
HEATER SUSPENDED—UNIT— DISTRICT NO GROUP ZONE Es$ED BY
WALL-
55
INSPECTION REG RD O
atV
OOr
Plan check fee 25°,6 Of above S
PERMIT ISSUING FEE; d
TOTAL FEE
PAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO
. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND I
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING HEATING VENTILATING AIR
CONDITIONING
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF APPROVALS DATE INSPECTO IGNATURE
CHAPTER 9 DIVISION 3 O THE BUSINESS AND PROFESSIONAL CODE
OF THE STATE OF C LIF , ROUGH
SIGNATURE FINAL
OF PERMITTEfY
PLAN CHECK VALIDATION CK M0 CwH PERMIT VALIDATION cK Mo CASH
WORKERS COMPENSATION S�
POLICY HOLDER:`% � X 5 2 O�FEB 7 4 1 0 6 4.5 0 ,&��
POLICY NUMBER- WN 77 -11377 ®T
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