HomeMy Public PortalAbout4835 RIO HONDO AVE_Mechanical__ TBAf@iIli 3APPLICATION FOR PERMIT -
v ``'-,._jtEATING - VENTILATING - AIR CONDITIONING
BUILDING AND SAFETY DIVISION
FA
APPLICANT TO FILL IN BUILDING II
(PRINT OR TYPE ONLY) ADDRESS 4�rP.95S' O�7/ I/iE�•
LOCALITY
FAPPLIANCEOR EQUIPMENT FEE NEAREST
CROSS ST.�puiZ /7 Z U /J
PTION UNIT, BTU D4 S�QOWNERNDLING UNIT, CFM MAILADDRESS, BTU CITY -�'5M,04 / TEL. NO. /`ESSOR, BTU CONTRACTOR Q ♦�lti ,O/`rL /ftL
VENTILATION SYSTEM ADDRESS
�.S- Se_/nor r!
EVAPORATIVE COOLER CITY IeSCdn TEL. NO.FURNA
FLOORCE: FAU BTU RAVITY LICENSE NO. `- CLASS C-ATE LIC. ,�
HEATER: SUSPENDED UNIT_ DISTRICT NO. GROUP ZONE PRO SED BY
WALL 7 �� v
C7
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INSPECTION RECOR
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Plan check fee 25% of above.
PERMIT ISSUING FEE $ S"d
TOTAL FEE
PLAN CHECK APPLICANT
NAME t
ADDRESS
CITY TEL.NO. I
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY r -�! I •�
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI-
NG
ENTI-
LATING,AIR CONDITIONING.
1 HEREBY CERTIF THAT I AM NOT ACTING IN VIOLATION APPROVALS �I7A INS�EfrT SIG��� Ey v
OF CHAPTER 9, DI 10 3, OF THE BUSINESS AND PROFESSIONAL j� ry
CODE OF THE STA E OFC LIFORNIA. ROUGH W r
SIGNATUREFINAL
OF PERMITTEE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VAL ATION eK. M.O. CASH
3L �. •pry. 1 2.0 0 .9u