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76A364E[ - CEBIlB-9/75 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
' BUILDING AND SAFETY DIVISION
FOR APPLICANVTO FILL IN BUILDING
(PRINT OR TYPE ONLY) ADDRESS 10659 E. Falrhall "
LOCALITY Temple City
NO TYPEOFAPPLIANCEOR EQUIPMENT FEE NEAREST
CROSS ST
ABSORPTION UNIT, BTU
OWNER Morgan Fishback
AIR HANDLING UNIT, CFM MAIL
ADDRESS'' 10659 E. Fairhall
BOILER, BTU CITY Temple "City - TEL No 448-2130
COMPRESSOR, BTU CONTRACTOR Bryant Heat. & Air Cond. Inc.
VENTILATION SYSTEM ADDRESS 1350 E. Inas Tunas`Drive
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EVAPORATIVE COOLER, CITY San Gabriel TEL NO 286-1141
1 FURNACE FAU X GRAVITY STATE LIC
FLOOR BTU 80M 7 50 LICENSE NO 221751 CLASS C20
HEATER SUSPENDED UNIT_ F DISTRICT NO GROUP ZONE PROsED BY }
WALL & / , i. D Gn5
INSPECTION RECORD H
1 W
CL.
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Plan check fee 25% of above
PERMIT ISSUING FEE $ 4 50
TOTAL FEE - 12,00 d 1
PLAN CHECK APPLICANT'
NAME
ADDRESS
CI TY TEL NO
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ..
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING VENTI- `
LAT IN
G AIR CONDI NTNG
I HEREBY C RTIF THAT I SAM N ING IN VIOLATION APPROVALS DATE INSPECTOR'S SIGNATURE
OF CHAPTER 9 D V N 3 OF THE BUSIN AND PROFESSIONAL
CODE OF THE ST CALIFORNIA ROUGH
SIGNATURE '
OF PERMIT FINAL
PLAN CHECK VALIDATION M D CASH PERMIT VALIDATI N K- M o CASH
CK
1 2,0 U A-16
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