HomeMy Public PortalAbout9332 BROADWAY_Mechanical__ ""'°" Ce"'a '"' APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
BUILDING A SAFETY DIVISION -
FOR APPLICANT TO FILL IN BUILDING y 3�
(PRINT OR TYPE ONLY) ADDRESS
LOCALITY
NO. TYPE p OF PLANCE OR EQUIPMENT FEE NEAREST
CROSS ST.
ABSORPTIONUNIT, BTU
OWNER
AIR HA NDLING UNIT, CFM MAIL
ADDRESS
BOILER, BTU +r CITY TEL. NO: _;7
COMPRESSOR, BTU y CONTRACTOR A oovv
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CITY sjj GD � TEL. NO,
FURNACE: FAU GRAVITY_ STATE u LIC.
FLOOR BTU LICENSE NO. CLASS
HEATER: SUSPENDED—UNIT— DISTRICT NO. GROUP NE �caQE SS ED BY
WALL o _.I IC
/J o'
•'7— t l v
INSPECTION RECORD - 1��
Ci
W
• y
' z
Plan check tee 25%G of above.'
PERMIT ISSUING FEE S ZISQ
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
1 HE>UY ACKNOWLEDGE THAT I HAVE READ'THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ONOINANCES AND LAWS REGULATING HEATING, VENTI-
LATING, AIR CONDITIONING.
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION APPROVALS DATE INSPECT SW E '
OF CHAPTER 9, DIV15ION 3, OF TH9 BUSINESS AND PROFESSIONAL �� 1
COON OF TH[ M NI STATE OF CALROUGH
SIGNATURE /�' r I
OF PERMITTEE FINAL
PLA CHUCK VALI ION CM. M.O, CASH PERMIT VALIDATION GK. M.D. CASH
6.0 1.�CEC 2 41 Q 1 9.5 0 v:w
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