HomeMy Public PortalAbout4836 TEMPLE CITY BLVD_Mechanical__ 76""E Ice eIaAI 11/Te APPLICATION FOR PERMIT
- HEATIN VENTILATING - AIR�SO/NDITIONING
C U F LO AN L•E E`S—L�
DEPARTME OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUILDIN
(PRINT OR TYPE ONLY) ADDRESS
LOCALI
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROSS ST
ABSORPTION UNIT BTU I
OWNER
AIR HANDLING UNIT CFM MAIL
ADDRESS
BOILER BTU CITY TEL NOL _
COMPRESSOR BTU CONTRACTOR
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CITY TEL NO _
FURNACE FA U GRAVIT STATE LIG
FLOOR BTU LICENSE NO C L A
HEATER SUSPENDED —UNIT— DISTRICT NOGPOW N
1�JT\/ONE' OCESSED BY
WALL 1
4f� --7-7-
INSPECTION
zINSPECTION RECORD O
V
Is
0
Plan check fee 25% of above y
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 ACRE COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING HE NG VENTILATING AIR
CONDITIONING
I HEREBL
RTIFY THAT I AM NO ;CTI IN VIOLATION OF APPROVALS DATE INSPECTOR 5 SB)NATURE
CHAPTER 9 DN 3 OF T E INE S AN ROFESSIONAL CODE
OF THE STATELIFORN ROUGH
SIGNATURE FINAL �'I g��
OFPERMITTE
PLAN CHECK V LIDATIOW CK No CASH PERMIT VALIDATION cK No CASH
VfORKERS COMPENSATION
POLICY HOLDER: ,�Ze��nwL 9 B 9�SEP 22 41 a - 9.5 0 •
POLICY NUMBER. ss- 27-Z-05_10
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