HomeMy Public PortalAbout5642 MCCULLOCH AVE_Mechanical__ .,.
7eA364E- C6.I853'9i75 APPLICATION FOR PERMIT -
HEATING -,VENTILATING - AIR CONDITIONING
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUILDING
(PRINT OR TYPE ONLY) ADDRESS )
LOCALIT o
NO. TYPEOFAPPLIANCE OR EQUIPMENT FEE NEAREST
Oak OF'
CROSS ST.
ABSORPTION UNIT, BTU ve
OWNERi
AIR HANDLING UNIT, CFM MAIL
A DDRESS'�(j
BOILER, BTU CITY•PniTEL. NO.
COMPRESSOR, BTU CONTRALTO _ vCir,
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VENTILATION -SYSTEM ADORES E
EVAPORATIVE COOLER CITY TEL. NO.
FURNACE: FAU_GRAVITY -may STATE �LIC. /^
FLOOR BTU �� {/ LICENSE NO —�/`�CLASS " I
HEATER: SUSPENDED UNIT_ DISTRICT NO. GROUP ZONE OCE s D BY O.
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WALL 06) t
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CD
INSPECTION RECOK6. cnw
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Plan check fee 25% of above.
PERMIT ISSUING FEE $
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
1 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 AC IN VIOLATION 1 APPROVALS DATE INSPECTOR'S SIGNATURE
OF CHAPTER 9, DIVISION 3, OF THE USINES AN PpOFESSIONAL
CODE OF THE S 0 LIFa"I ROUGH ! .�
SIGNATURE FINAL
OF PERMITTEE
PLAN CHECK VALIDAT o CK.- M.O. CASH PERMIT VALIDATION cK. M.o. CASH
.2�2 AUG 12. 4 1. B 1 :9.5.0