HomeMy Public PortalAbout5650 MCCULLOCH AVE_Mechanical__ 76A%748 CEBIBF-9 75 APPLICATION FOR PERMIT
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 v—
ADDRES a' C
BOILER, BTU CITY T NO.
7COMPRESSOR, BT CONTRACTOR
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CITY )e TEL. NO. �P
F U R N A C AU G R&VITY STATE `l LIC.
FLOOR BTU LICENSE NO. '0z7(= �_ CLASS
HEATER: SUSPENDED UNIT_ DISTRICT No. GROUP ZONE PROLELS D4BY
WALL _ c
INSPECTION RECORD Imo.
v
W
CL
Plan check fee 25%of above.
PERMIT ISSUING FEE $
TOTAL FEE
0
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 ACTT I VIOLATION APPROVALS DATE INSPECTOR'S SIGNATURE
OF CHAPTER 9, DIVISION 3.1 OF THE BUSINESS U A
CODE OF TN ALIFOR-NI A. ROUGH
n
SIGNATURE
OF PERMITTEE
FINAL
r
PLAN CHEC VALIDATN PERMIT VALIDATION CK. M.O. CASH
CK. M.O. CASH
I •
n� 6 1 71ti.AUS- 12 4,1 B 19.5-C) ASS