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P - 43795
Building MECHANICAL Inspections RESIDENTIAL APPLICATION �63-s�2-3604 CITY OF FRIDLEY 763-502-4977 FAX EFFECTTVe �-i-2o>> DATE SITE ADDRESS � THIS APPLICANT 1S PROPERTY OWNER/ TENANT �OWNER ADDRESS: YOUR E-MAIL ADDRESS � �� ❑CONTRACTOR CONTRACTOR COMPANY NAME: SUBMIT A COPY OF CONTACT PERSON: YOUR STATE STATE LICENSE # EXP DATE LICENSE WITH ADDRESS: CITY APPLICATION PHONE FAX z PERMIT TYPE �'SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: DETAILED O NEW � ON OF W ORK ❑ ALTERATION/REMODEL Permit No. Received By 1��� Date��l: ;�, � 11 t(�.1; U �1e► Zi$f� 1'E ZIP FEES ARE BAS�D ON $10.00 PER FIXTURE, EXCLPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK. Equipment Installed MFG: MODEL: S[ZE/BTU MFG: MODEL: MFG: MODEL: A/C $25.00 FIREPLACE (GAS) $15.00 AIR TO A[R EXCHANGBER $15 FIREPLACE (WOOD) $35.00 BOILER $35.00 FURNACE $35.00 _CHIMNEY LINER $10.00 GAS DRYER $10.00 �DUCT WORK $10.00 �GAS PIPING $10.00 SIZE/BTU SIZE/BTU GAS RANGE/OVEN $J0.00 NEW GAS GRILL $10.00 GAS UNIT HTR $10.00 _POOL HEATER $35.00 VENTILATOR $I5.00 THIS IS AN APPLICATION FOR A PERMIT-NO? VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and w' h the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to st without a permit; that the work will be in accordance with the approved plan in the case of all work w i h re ires re ' w and appr al of plan SIGNATURE OF APPLICAN �� � T NAMTj�����?�-��T DATE I�y' I�/1 �V APPROVALINSPECTORSSIGNA DATE City of Fridley Buil ing Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 � �� � �`� �� l � ��� � � � � � , ,; � � �� . � � � , : , ,. . , ,, r . � , 1� �- _ .. - � c'� F o o�l ,: � ; ; ' ' a �' �� ��f � ,��s������� ,�-,� ��i s ��� �/q �� TU - ; . , _ _, _ _ _ . . , , _<< , , � ,r o_ ; , r _ , � ; p_ ��f�K � ,_. . f � ` " ; i � � � � ; i � � , I tl� ,........� ..... .,.,',.. . . ��. 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