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A 364 - CE 818 -1/75 -
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
a'ty Of ?`oCO NTYYM '►L S'o%fA. 3L S BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY 5400 (;Olden Wrost lot 0
19
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
-- MAIL
Np TYPE&SIZE OF EQUIPMENT FEE ADDRESS fqmiftnjno
SEE BACK OF APPLICATION
- CITY TEL. NO.
FORCE AIR FURNACE, BTU
lla- CONTRACTOR
COMPRESSOR, BTU -
4SJ.-�a�i' i ADDRESS
VENTILATION FAN
CITY A� TEL. NO. '337--o6732,7--o6n
LIST ALL OTHERS BELOW STATE LIC.
LICENSE NO. CLASS '1
DISTRICT NO. I GROUP ZONE PROCESSED 8,
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INSPECTION RECORD 0
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Plan check fee. See reverse. _ I—
NF�It\IIT 1 �I l\G FTl. S
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY - —
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, V£NTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING.
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION --
OF CHAPTER 9. DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL i -
CODE OF THE STATE OF CALIFORNIA. zV
SIGNATURE PERMIT VALIDATION
OF PERMITTEE_��
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PLAN CHECK VALIDATION CK. M.0. +2+a5H+
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