HomeMy Public PortalAbout4847 CLOVERLY AVE_Mechanical__ L 4 e
76A36`E- CIE.;oB-,ai75 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
BUILDIN AND SAFETY D�N
FOR APPLICANT TO FILL IN BUILDING
(PRINT OR TYPE ONLY) ADDRESS a�
LOCALITY
NO TYPE OFAPPLIANCEOR EQUIPMENT FEE NEAREST
CROSS ST
ABSORPTION UNIT, BTU
1 OWNER 9
AIR HANDLINGIUNIT, CFM MAIL
ADDRESS
BOILER, BTU CITY G TEL NOZ97_'8w
COMPRESSOR, BTU ^
CONTRACTOR co AJ-13 7 C flC}v 141
VENTILATION SYSTEM ADDRESS2122-3 4-1-7
EVAPORATIVE COOLER CITY 7�j Q TEL NO
FURNAFLOORCE FAU BTU ITY STATE Lic
LICE SE NO �/�% j(J CLASS
HEATER SUSPENDED UNIT_ DISTRICT No GROUP ZONE cessED BY a-
O
= 1 WALL v
5 49 E O
a INSPECTION RECORD Lu
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coo
,Z
,Plan check fee 2517o of above
- PERMIT ISSUING FEE $
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS t
CITY TEL NO
r
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT,.ANO AGREE TO COMPLY
WITH ALL ORDINANCES'AND LAWS REGULATING HEATING VENTI-
LATING, AIR CONDITIONING -
I HEREBY CERTIFY THAT I )AMNOT ACTING IN VIOLATION APPROVALS DATE INSPECTOR S SIGNATURE
OF CHAPTER 9 DIVISION 3 OF TSINESS AND PROFESSIONAL
CODE OF THE STATE OF CA IFOR ROUGH` =/Z-ZZ?�
SIGNATURE r
OF PERMITTEE V < FI NAL
PLAN CH ALIDATIONCK O CASH
PERMIT VALIDATION cK M o CASH
M
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8"O 5 DEC 16 4 1 1 2.0 0'Ab,3