HomeMy Public PortalAbout8720 BURGHARDT RD_Mechanical__ 76A36CE ICE`if16A1- II/76 APPLICATION FOR PERMIT
HEATIN VENTILATINGG]r- `A(((IR CONDITIONING
C UNTY OF LOSLES
DE RTMENT OF COU Y ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BADUDRESS
ILDING
(PRINT OR TYPE ONLY( Sow
LOCALITY �lN �_
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE Com/
NEAREST
CROSS ST.
ABSORPTION UNIT.BTU
OWNER ,tel .5 . _. ,1..� e
AIR HANDLING UNIT,CFM MAIL c�7 /'r� W/Sil/ ,,D
ADDRESS O /2V�/72, N
BOILER.BTU /�
CITY � 6 TEL.NO.q[_`�_C�/
COMPRESSOR.BTU 3� CONTRACTOR ••� OL
VENTILATION SYSTEM ADDRESS '
EVAPORATIVE COOLER CITY TEL.NO.
FURNACE: FAUGRAVITY STATE LIC.
FLOOR BTU ILICENSENO. CLASS
HEATER: SUSPENDED_UNIT_ DISTRICTNO. GROUP ZONE PnOCESSED-Bv
WALL
Cq ,r >
INSPECTION RECORD 6
O
u
O
Plan check fee 25% of above.
IYi
PERMIT ISSUING FEE$ Z
TOTAL FEE
+ PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND -
STATE THAT THE ABOVE 15 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 I,SPECTOR'S SIGNATURE
t' CHAPTER 9. DIVISION 3, OF THE BUSINESS ND PROFESSIONAL CODE
OF THE STATEOP LFORNIA. ////� ROUGH
I: SIGNATURE /�y��///JJ` FINAL
OF PERMITTE �2(!-(�
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. - CASH
2 0 3�JAN 23 41 D _1 .x:0 0 &z
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