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76A364K=°�B1:Y-9/75 APPLICATION'FOR PERMIT
HEA•TIN.G - VENTILATING - AIR CONDITIONING LJ
BUILDIN AND SAFETY,,.DIVISION
=. FOR, APPLICANT TO FILL IN BUILDING .
(PRINT OR TYPE ONLY) ADDRESS
LOCALITY
NO. TYPE OFAPPLIANCEOR EQUIPMENT FEE NEAREST
CROSS ST. •
ABSORPTION UNIT, BTU
OWNERAl Ito-4
AIR HANDLING UNIT, CFM MAIL
ADDRESS
BOILER. BTU CITY r TEL. NO.[�� _
COMPRESSOR, BTU CONTRACT
'l �-
VENTILATION SYSTEM ADDRESS SSv
EVAPORATIVE COOLER CITY �ySTATE' TEL. NO. ��, Q/
FLOORFURNACE: FAU BTU RAVITY LICENSE NO. 1910 Q CLASS 1-?ZID
Y'
HEATER: SUSPENDED UNIT_ DISTRICT NO. GROUP ZONE CESSED BY �-
WALL- G v
,4- - 1 o
INSPECTION RECORD W
• � a
z
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 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 BU INESS AND PROFESSIONAL
CODE OF THE STATE CALIFORNIA. ROUGH �-
OF PESIGNAU TTFINAL �•
OF RMITTE !!"��
PLAN CHECK•VALIDATION CK.. M.0. CASH
PERMIT VALIDATION M.O. CASH
6 1 9�UGT 841, 0 _�:. 1.2..0 .0
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