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76A364Er•CE818B 9/76 - :. APPLIC:AT.ION FOR PERMI�Y .
HEATING - VENTILATING - ABI$ CONDITIONING '
BUILDING AND SAFETY DIVISION
FOR-APPLICAUT TO FILL IN', BUILDING Zc
(PRINT'OR TYPE ONLY) 'ADDRESS j -
LOCALITY,
NO. TYPE OFAPPLINNCEOR EQUIPMENT FEE
NEAREST
CROSS ST:
ABSORPTION UNIT, BTU
OWNER
tr .
AIR HANDLING UNIT, CFM MA9L
ADDRESSAO
BOILER, BTU CITY TEL.""NO. '
COMPRESSOR, BTU CONTRACTO � J
VENTILATION. SYSTEM ADDRESS -
EVAPORATIVE COOLER CITY. ��` TEL
..N0.37a�-/.�_e✓�. +
FURNACE: FAU GRA,VI`TY STATE 2. "LIC.
FLOOR BTU ,Q LICENSE NO. / � ' CLASS'" 40
HEATER: SUSPENDED UNIT'_ DISTRICT No. GROUP
ZONE .PROCESSED-,BY
WALL o.
0 c v,
c
1NSFECTION RECORD
Plan check fee 25% of above. . f
PERMIT.ISSUING-FEE $
TOTAL FEE
PLAN CHECK APPLICANT "
,'NAME.
.ADDRESS "
CITY TEL.NO.
"I HEREBY ACKNOWLEDGE. THAT ('.HAVE READ THIS APPLICATION '
AND STATE THAT-THE ABOVE. IS CORRECT AND AGREEJO COMPLY -
WITHi ALL ORDINANCES AND, LAWS REGULATI.N G" HEATbNG', VENTI- -
LATING,"'AIR CONDITIONING,. -
I HEREBY CERTIFY THAT I AM NOT` ACTING IN VIOLATION APPROVAL'S- DATE INSPECTOR'S SIGNATURE '
OF CHAPTER 9, D1 VI � -0F 7HE..BUSINESS D PRO�FES
CODE OF.THE STA OF AIIFOR NIA ROUGH -
SIGNAT-URE
.:'O FPERMI .,� FINAL �^
PLAN CHECK VALIDATION cl- M D' CASH
MIO VALIDATION CK. M.O. cas
1 b fl„•. .6. 4 -0 1L1
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