HomeMy Public PortalAbout5827 MYDA AVE_Mechanical__ 7G"36`E-CRO180-9/75 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
BUILDING AND SAFETY DIVISION 1
FOR APPLICANT TO FILL IN BUILDING
GC/ (J
(PRINT OR TYPE ONLY)
LOCALITY
NO. TYPE OFAPPLIANCEOR EQUIPMENT FEE
NEAREST
�J �.
ABSORPTION UNIT, BTU CROSS ST.
OWNER
AIR HANDLING UNIT, CFM MAIL
ADDRESS �J
BOILER, BTU CITY TEL. NO. D
COMPRESSOR, BTU CONTRACTOR
bF2.
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CITY � r TEL. NO.`
FURNACE: FAU_GRAVITY STATE LLIIC.
FLOOR BTU LICENSE NO. C,�I>f___1 CLASS
HEATER: SUSPENDED UNIT_ DISTRICT NO. GROUP ZONE
WALL PROCE E BY °-
/C
Al a
o
E-
INSPECTION RECORD Lv,�
JZ / �
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 BUSI S AND PROFE SIGNAL
CODE OF THE STATE OF CAL) ORNI ROUGH /1
SIGNATURE --��
OF PERMITTEE r FINAL B.'�-'l�j ter• �,�i
PLAN CHECK VALIDATI N CK. CASH PERMIT �A IDATION CK. M.O. CASH
0 1 r--NOV y 41 U 1 9.5 O Az;-,.