HVACPERMIT APPLICATION CITY OF GRAMBLING 127 King Street Grambling, LA 71245 Telephone (318) 247-6120 Fax: (318) 247-0940 Type of Permit Applying: □ HVAC Permit for New Construction □ HVAC for Repairs or Installation on Existing Building PROPERTY Location: _____________________________Tax Parcel No. _______________ Property Area (Sq. Ft) ______ Owner(s):________________________ Address: _________________________________ Corner lot □Yes □No APPLICANT INFORMATION Applicant:____________________________________ License #___________________________ Liability Insurer: __________________ Name: ____________________________ Title:____________________ Email: __________________________ Cell #: ____________ Address:____________________________ City: _________________ State: ____ Zip:______ Phone #: __________ Fax#: __________

NEW CONSTRUCTION INFORMATION General Contractor Name:_______________________ Address:____________________________ City: ____________ State: __Zip:______ Phone Number: ____________ Cell: ____________ Fax: _____________Email: ________________________________________

REPAIR OR MINOR INSTALLATION INFORMATION Detailed description of repairs or installations to be performed:_________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ FEES AND PROCESS HVAC Permits for new construction will not be issued until after Building Permit issued. HVAC Permits for repairs or minor installations on existing buildings cannot be issued without a copy of a valid HVAC/Mechanical Work license and proof of insurance. CERTIFICATION I acknowledge that this permit becomes null and void if work authorized is not commenced within 180 days after permit issued. I have read this application in its entirety and required attachments and affirm that all are true. _______________________________ __________________________________ _________________ Signature Printed Name Date REQUIRED ATTACHMENTS □ Copy of HVAC/Mechanical Work License □ Copy of Certificate of Insurance □ Application Fee

OFFICIAL USE ONLY App. Rec’d ___/___/__ Fees Rec’d _______________ Permit Issued:___/___/__ Reviewed and approved ___/___/__ ____________________ (Signature approving)

HVAC PERMIT FEES: New: $75.00 Repair/Minor Installation: $40.00