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76A394E - CH919G-9/79 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
City of Tees City, 1,i(), A2982
BUILDING AND SAFETY DIVISIO
OR APPLICANT TO FILL IN BUILDING
(PRINT OR TYPE ONLY) ADDRESS 1.49
LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST ,
CROSS ST.
ABSORPTION UNIT, BTU
OWNER
AIR HANDLING UNIT, CFM MAIL
ADDRESS
BOILER, BTU - 142;5 naUas Low
CITY A ,r. TEL. NO.
COMPRESSOR, BTU 48#000 - r CONTRACTOR
UZOM A/C
VENTILATION SYSTEM ADDRESS -
712
EVAPORATIVE COOLER CITY Azum TEL. NO.
FURNACE: F4,U GRAVITY STATE 2-17573 CLASS
3 FLOOR BTU .; LICENSE NO.
O
HEATER: SUSPENDED UNIT_ DISTRICT NO. GROUP ZONE PROCESSED BY CS
WALL J
INSPECTION RECORD
290
a
W
Plan check fee 25% of above.
PERMIT ISSUING FEE $ { .
TOTAL FEE OX
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI-
LATING, AIR CONDITIONING.
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION APPROVALS DATE INSPECTOR'S SIGNATURE
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL ROUGH
CODE OF THE STATE OF CALIFORNIA.
SIGNATURE
OF PERMITTEE - FINAL
PLAN HECK VALIDATION PER�MITrVALIQATI N cK. M.O. CAS
CK. M. CASH i
I