HomeMy Public PortalAbout5326-30 GLICKMAN AVE_Mechanical__ 76A364 - CE818 - 3-69 APPLICATION FOR PERMIT
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HEATING - VENTILATING - AIR CONDITIONING
COUNTY
DEPARTMENT OF COUNTY ENGINEER FNEARE7ST
BUILDING AND SAFETY DIVISION
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W.JENKINS,SUPERINTENDENT OF BUILDING
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL / "
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS 7 (p L i
ABSORPTION SYSTEM, BTU �U _ n CITY �/ TEL. NO. 1/5/-3 9-UY
Y
AIR HANDLING UNIT, CFM CONTRACTOR _
ADDRESS
BOILER, HORSEPOWER
CITY TEL. N0.
COMPRESSOR, HORSEPOWER STATE LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER ��
FURNACE: FAU G AV;-TY J
�-1 t � INSPECTION RECORD
FLOOR BTU
HEATER: SUSPENDED UNIT
WALL }
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0
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NEW"ADDITION_ PERMIT $ 3 00 z
ALTER_REPAIR_ TOTAL FEEIla
$
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL. N0.
IHEREBY 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- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING.
IHEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH
CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STATE OF CALIFORNkA. U
SIGNATURE ® ) JACK R. ALLEN, UPER ISING MECHANICAL ENG'R.
OF PERMITTEE ��(.�/� /,i�
PERMIT VALIDATION CKi M.O. CASH
PLAN CHECK VALIDATION
IAr- 6.436" � 324 41 D 15.50
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE �: