HomeMy Public PortalAbout5032 PERSIMMON AVE_Mechanical__ 76A666E-`CRiB18B;6175 APPLICATION FOR PERMIT
'~~ HEATING - VENTILATING - AIR CONDITIONING
BUILDING AND SAFE DIVISION
FOR APPLICANT TO FILL IN LEA
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NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ITY��rn 1 Cw
ST
ST.
ABSORPTION UNIT, BTU
OWNER Cjo,,
-AIR HANDLING UNIT, CFM MAIL
{ ADDRESS -14
BOILER, BTU CITY TEL. NO.
COMPRESSOR, BT , U CONTRACTOR
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CITY �- TEL. NO. -f4(14 67�,L,
FLOOR
FURNACE: FAU BTU R T STATE ICE SE NO. �V/ /� CLASS
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1 HEATER: SUSPENDED UNIT_ DISTRICT NO. GROUP ZONE PR SSED BY �-
WALL � A o
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INSPECTION RECORD w
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Plan check fee 25% of above.
PERMIT ISSUING FEE $
TOTAL FEE
PLAN CHECK APPLICANT
NAME'
ADDRESS
CITY jb TEL.NO. 4/k/j 4 f`
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 VIOLATIONAPPROVALS DATE INS PECTOR'S SIG NATURE
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL
CODE OF THE STATE OF C LIFOR NIA. ROUGH - `g '�1. ���i:'�j�•.r,�, ,},�.�r��?�
SIGNATURE TJ!
OF PERMITTEE FINAL
PLAN CHECK VALIDATION K. M.O. CASH
PERMIT VA LI D�TION CK. ',l0 ' CASH
WORKERS COMPENSATIO-M
" -9 4 3 NJAN 3 4 1 D 5 -.5 0
POLICY HOLDER:�fomew `lwpc-m r`f
POLICY NUMBER: IVA -77- x'9571