P - 42101Building
Inspections
763-572-3604
763-502-4977 FAX
DATE � � /
SITE ADDRESS _ '�,'�' ,�'
TH1S APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOURSTATE
LICENSE WITH
APPLICATION
PERMIT TYPE
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
_ EFFECTIVE 1-1-20] 1
l�' ,� �,1�
❑ OWNER
NAME:�
ADDRESS:�
PHONE:__��
COMPANY NAME:
CONTACT PERSON:
STA7E LICENSE #�
ADDRESS:
PHONE
GLE FAMILY
TYPE OF WORK: I� NEW
DETAII,EDyDESCRIPTION OF
YOUR E-MAIL ADDRESS L. _`7C,L.t-
)N7RACTOR
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7- / 7�.
❑ TWO FAMILY
�ENT
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
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a. � _.
Permit No.:
Received By:�
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STATE�21P �� e
STATE ZfP
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTCIRES: ([NDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALC'S PER MANUA J 2006 ASHRAE HANDBOOK %�
Equipment Installed MFG: �Yh2 MODEL:�/%�[i�i��d S1ZE/BTU 1.���/ �
MFG: ��vl� MODEL: ��e�� SIZE/BTU_�s�?(/(7//
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MFG: MODEL:
A/C $25.00 FTREPLACE (GAS) $ I5.00
AIR TO AiR EXCHANGEER $15 FiREPLACE (WOOD) $35.00
_BOILER $35.00 �F�URNACE $35.00
CHIMNEY LiNER $10.00 '�'iAS DRYER $10.00
_DUCT WORK $10.00 _GAS PIPING $10.00
S1ZE/BTU
_GAS RANGE/OVEN $10.00
_NEW GAS GRILL $10.00
_GAS UNIT HTR $10.00
POOL HEATER $35.00
V EN7ILATOR $15.00
\ / THIS IS AN APPLICATION FOR A PERMIT-NOT 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 c des o�xhe ' idley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an ap ' ation r and work is ot to start without a permit; that the work will be in accordance with the
approved plan in the case f all or r ui s review an approval of plans.
SiGNATURE OF APPLICA PRINT NAME r`j� T� (�
APPROVAL INSPECTORS SI ATURE ' DA7'E
�
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977