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li """" " ' '/" APPLICATION FOR PERMIT
r.� HEATING - VENTILATING - AIR CONDITIONING
BUILDING AND SAFETY DIVISION
F R APPLICANT TO FILL IN ADIDRESS / N.
(PRINT OR TYPE ONLY)
LOCALITY
NO. TYPEOFAPPLIANCEOR EQUIPMENT FEE NEAREST
CROSS ST.
ABSORPTION UNIT, BTU
OYiN ER b
AIR HANDLING UNIT, CFM MAIL
A D DR ESS
BOILER, BTU CITY TEL. NO. Zr/.,
COMPRESSOR, BTU CONTRACTOR
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOT Ek CITY TEL NO.
FURNACE: FAU GRAV TY STATE LIC..
FLOOR BTU LICENSE NO. CLASS
HEATER: SUSPEINDED UNIT_ DISTRICT N0. [ROUP z N PROC[ en eY po
WALL U
�y Q CD
INSRgC0L
T1N RCOR Iy Lu
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Plan check fee 25% of above.
PERMIT ISSUING FEE $
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THFE APPLICATION
AND STAT[ THAT THE ABOVE I! CORRECT AND AGREE TO COMPLY
WITH -.LL ORDINANCES AND LAWS R[Gy LATING HEATING, VENTI-
LASING, AIR CONDITIONING.
'I HEREBY CERTIFY THAT I AM NOT AC NG IN VIOLATION APPROVALS DATE INBPECTOI SSIGNATURE
OF CHAPTER D, DIVISION 3, QF THE BUSINESS ND IN
COO[ OF TH[ STATE OF CALIFORNIA. ROUGH ��11
SIGNAT
URE
OF PERMITTEE FINAL
OF PE
PLAN CHECK VALIDATION M.O. CASH
PERMIT VALIDATION CK. .0. CASH
53 a .6 4.1- f 1 2.0 0 A*
U .