Fillable PERMIT APPLICATION City of Azusa (626) 812-5234 213 (City of Azusa)

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PERMIT APPLICATION City of Azusa (626) 812-5234 213 (City of Azusa)

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City of Azusa
213 E. Foothill Blvd.
Azusa, CA 91702-1395
(626) 812-5234
PERMIT APPLICATION
TYPE OF CONSTRUCTION
VALUATION
OCCUPANCY TYPE
CITY
STATE
ZIP
PHONE
CITY
STATE
ZIP
PHONE
PHONE
CITY
STATE
ZIP
EXPIRATION DATE
CITY LICENSE NO.
ELECTRICAL SYSTEM
Description
Outlets:
MECHANICAL SYSTEM
Up to 1 HP, KVA, KW
210 - 1K Amp.
> 1K Amp. or > 600v.
Furnace:
Compressor:
PLUMBING SYSTEM
Toilets/Urinals
Bath Tub
Shower
Lavatory
Sinks
Floor-Sinks/Drains
Kitchen Sinks
Bar Sinks
Ventilation Sys
tem
A
pplicant:
Date:
Light Fixtures
< 200 Amp.
Fixed Appliances 1HP or Less:
BTU
Description
Air Conditioning
Number of Air Registers
Duct Alteration
Air Handling Unit:
Number
CFM
Boiler:
BTU
Evaporative Cooler
Other:
# of Units
# of Units
# of Units Description
Receptacles /Switches
Power Apparatus & Large Appliance:
# of Units Description
Floor
Gravity
BTU
Heater:
Suspended
Unit
Wall
Services, Panels, Boards > 600v.:
Clothes Washer
Pool Piping
Lawn Sprinkler System
Water Heater
Gas System
Gas Outlets
Water Service
Repipe
Descri
ption# of Units
Temporary Power Pole / Appurten.
Number
Number
FAU
# of Units Description
# of Units # of Units
Oven
Cooktop or Range
Hood
Disposal
W.M.
Room AC
Dryer
Miscellaneous
FAU or Heater
Fan
Dish Washer
Water Heater
I hereby certify that the foregoing is true and correct to the best of my
knowledge.
CHECK #
Signs - Circuit
CASH
1 to 10 HP, KVA, KW
50 to 100 HP, KVA, KW
10 to 50 HP, KVA, KW
Over 100 HP, KVA, KW
MASTERCARD
VISA
DISCOVER
LAST 4 DIGITS
EXP. DATE
ZIP
EXPIRATION DATE
PHONE
LICENSE TYPE
EMAIL
STATE LICENSE NO.
ADDRESS
BUILDING ADDRESS
DESCRIPTION OF WORK
SQUARE FEET
OWNERS NAME
EMAIL
ADDRESS
APPLICANT NAME
ADDRESS
CONTRACTOR
ADDRESS
STATE LICENSE NO.
ENGINEER
DESIGNER
ARCHITECT
$
Ventilation Fan
Sewer - New
CITY
STATE
CITY OF AZUSA - PERMIT WORKSHEET - Page 2
Additional Information for BUILDING - Please provide number of units, full description and size:
Additional Information for HVAC - Please provide number of units, full description and size:
Additional Information for ELECTRIC - Please provide number of units, full description and size:
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PERMIT APPLICATION City of Azusa (626) 812-5234 213 (City of Azusa)

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Completed 2 August 2020

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