HomeMy Public PortalAbout9128 LONGDEN AVE_Mechanical__ 76A364E - CL'B1BB-9/73 APPLICTION FORPERMT .
HEATING - VENTILATING -.AIR CONDITIONING
BUILDING AND SAFETY DIVISION
FOR APPLICANT' TO FILL IN BUILDING
(PRINT OR TYPE ONLY) ADDRESS
LOCALITY
NO TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST
CROSS ST.
ABSORPTION UNIT, BTU
OWNER
AIR HANDLING UNIT, CFM MAIL
ADDRESS g
BOILER, BTU CITY TEL NO.
COMPRESSOR,' BTU CONTRACTOR
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CITY TEL. NO
FURNACE: FAU_GRAVITY STATE LIC
FLOOR BTU LICENSE NO. CLASS
HEATER. SUSPENDED UNIT DISTRICT NO GROUP ZONE PROC s Dar a
WALL t V
INSPECTION RECO
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1
Plan check fee 25% of above '
PERMIT ISSUING FEE'$
TOTAL FEE
PLAN CHECK APPLICANT-
NAME
ADDRESS
CITY TEL NO
I 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
I HEREBY CERTIFY QOF
M NOT ACTING IN VIOLAq�TION APPROVALS DATE INSPECTOR'S SIGNATURE
OF CHAPTER 9, DIVISION (NESS AND PROFE5511b NAL
CODE OF THE STATE OF ROUGH X12 J�
SIGNATURE FINAL
OF PERMITTEE
PLAN CHECK VALIDATION CK M.o CASH P MIT VALIDATION CK. M.O. CASH
80 AYJ1041 D 1 2.0'0e