HomeMy Public PortalAbout10945 DAINES DR_Mechanical__ QV. �
76A354E" CEB,Ba '/" APPLICATION FOR PERMIT
HEATING VENTILATING - AIR-CONDITIONING•
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUILDING p
(PRINT OR TYPE ONLY) ADDRESS (S7 j
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NO. TYPEOFAPPLIANCEOR EQUIPMENT FEE NEAREST
NEAREST
CROSS ST.
ABSORPTION UNIT, BTU .�
OWNER �+
AIR HANDLING UNIT, CFM MAIL
ADDRESS 7
BOILER, BTU CITY TEL. NO. -
•i COMPRESSOR, BTU y �r®A - � CONTRACTOR.
G• G �
VENTILATION SYSTEM ADDRESS P .' -
EVAPORATIVE COOLER- CITY I '�. TEL. NO._q-3-7-G 7�
FURNACE: FAUGRAVITY STATE LIC.
FLOOR BTU-/Z: t- ` ' �� LICENSE NO. ' CLASS 4—"Z6
HEATER: SUSPENDED—UNIT DISTRICT NO. GROUPz�AoJNF PROC
�ED BY
WALL pp K� / ��-z.�f CpA
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INSPECTION RECORD H
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Plan check fee 25%D of above.
PERMIT ISSUING FEE $
TOTAL FEE
PLAN CHECK APPLICANT '
NAME
ADDRESS -
CITY TEL.NO.
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALLORDINANCES AND LAWS REGULATING HEATING, VENTI-
LATING, AIR CONDITIONING. - -
1 HEREBY CERTIF" HA AM NOY ACTING IN VIOLATION APPROVALS DATCE� INSP TOR'S SIGNATURE
OF CHAPTER 9,
DIV
i0N 3, F TME BUSINESS AND PROFESSIONAL ROUGH
CODE OF THE STA I CAL ORNIA. p q
SIGNATURE
OF FINAL (J / •�—�
PERMITTE
PLAN CHECK VALIDATION CK,. M.0. CASH PERMIT VALIDATION cK. M.O. CASH
1 90 !Itrd 0 2. 3 ? a