HomeMy Public PortalAbout9542 WEDGEWOOD ST_Mechanical__ 76A36AE•-CE8188-975 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
B U I NG AND SAFETY ISION
=FOR; APPLICANT TO FILL IN BUILDIhK
(PRINT OR TYPE ONLY) ADDRESS
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LOCALITY
NO. TYPE OFAPPLIANCEOR EQUIPMENT FEE NEAREST
• CROSS ST.
ABSORPTION UNIT, BTU
OWNER
AIR HANDLING UNIT, CFM MAIL
ADDRESS
BOILER, BTU CITY TE NO.
/ COMPRESSOR, BTU
CONTRACTOR
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COO CITY TEL. NO
FURNACE: FAUGR VITY STATE IC.
FLOOR BTU LICENSE NO. CLASS }
HEATER: SUSPENDED UNIT_ DISTRICT NO. UP ZONE /^PRQCESSED BY a
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WALL
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INSPECTION RECORD Lu
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Plan check fee 25% of above.
PERMIT ISSUING FEE $ O
TOTAL FEE r O
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.
N I HEREBY CERTIF AT 1 M/5TAC G IN VIDLATION APPROVALS DATE INSPECTOR'S SIGNATURE
OFCHAPTER 9, DIVI ON HES D PROFESS ONAL
CODE OF THE STAT OF L NIA ROUGH
SIGNATURE
OF PERM! EE FINAL ��"�•� w�� '
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PLAN CHEC AL1 ATION PERMIT VALIDATION K. M . CASH
CK, M.O. CASH
WORKERS COMPENSATION
TION
2 0 .5 ti'IAR 2.2 5 A 2 ?.0 0 ,&t-6
:POLICY HOLDEN: � _