HomeMy Public PortalAbout5318 WELLAND AVE_Mechanical__ Or
78A364E r•CS818B-975 APP TIO N�
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HEATING - VENTILATING - CONDITIONING•
77 QG
BUILDING AND SAFETY DIVISION 4 i.
FOR APPLICANT TO FILL IN BUILDING _
(PRINT OR TYPE ONLY) ADDRESS
LOCALIT.f
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST "
CROSS ST. ( �!
ABSORPTION UNIT-, BTU
OWNER ol
AIR HANDLING UNIT, CFM MAIL'
ADDRESS
BOILER, BTU CITY 'r TEL. NO.
COMPRESSOR, BTU { Aow
CONTRACTOR
VENTILATION SYSTE % ADDRESS
EVAPORATIVE COOLER CITY TEL. NO.
FURNACE: FAU_GRAVITY STATE LIC.
FLOOR BTU LICENSE NO.—,— CLASS C-
HEATER: SUSPENDED UNIT_ DISTRICT NO. GROUP ZONE PROC SED BY
WALL �-
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INSPECTION RECORD Imo-,
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Plan check fee 25%of above. '' I • . 4 rue--`�
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 T OVE IB CORRECT AND AGREE TO COMPLY'
_ WITN ALL ORD. CES ND LAWS REGULATING HEATING, VENTI-
LATING., AIR C DITION
I HEREB C J53,
AT 1. AM NOT ACT NG IN VIOLATION APFRQVALS DATE INSPECTOR'S SIGNATURE
OF CHAPTEji 9 IVO8 E BUSINESS �NO PROFESSIONALROUGHCODE OFT E TAT1 R A r!' Mg��
SIGNATU
OF PERMIT .FINAL
PLAN CH' CK ATION PERMIT VALIDATION CK: M.O. CASH
CK. M.O. CASH
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