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Inspections
763-572-3604
763-502-4977 FAX
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YOUR S'I�n'I�I�:
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nPPLICA"IION
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRI:DLEY
GI'FI?C"I�IVE I-I-201 I
YOUR L'-MAII, nDDRI�:SS _�_�_C�
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Permit No.: t
Received E3y
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COMP,ANY NnMI::_�'t'._L..L1�Li�2�� �-�—�A�-� `�"�C� � '--- ----- --
CONl�AC7' PI RSON: ��_.��,_ �'ZY JI(l�iC'�,i1 --
S'I'�"I'F, LICENSt�: # [?XP D�'I'[�:
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PERMIT TYPE �SINGLG FAMILY ❑'CWO FAMILY
TYPE OF WORK' � Nf:W �RIcPI.ACI>MEN'f
❑ TOWNHOUSI;
❑ ALI'ERATION/REMODC:L.
1 �J
DETAILED DESCRIPTION OF WORK ���.Q�_c�_�%�__��,(15�.��_ ___--
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F[:F.S ARE 13ASN:D ON �i10.00 PER FIXTURE, EYCF,P'f WHERE NOTED. FI�TURF.S: QNUICATH: TO"TAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALC'S PER MANI�AL.1200G ASHRAE HANDBOOK.
i?quipment Installed MFG:�•('�(�D _ MODI?L: ��:(��� SIZF.B7�U Z^��y'il
MFG:�(-�Q� MODF.I,�����0 SI'LE/B'1"U_����,�}_��
MFG: MODBL: SIZE/[3TU
I A/C $25.00 FIRGPLACF: (GAS) $I5.00 GAS RANGE/OVEN $10.00
AIR TO AIR �XCHANGGGR $IS FIRF,PLACC (WOODI $35.00 NEW GAS GRILL $10.00
[301LGR $35.00 �_FURNACE $35.00 _GAS UNI'T H"TR $10.00
CHIMNFY LINER $10.00 � GAS DRYER $10.00 POOL HEATER $35.00 �
DUCI WORK $10.00 GAS PIPING $10.00 _VGN'1'II.ATOR $I5.00
$ i �.�fl X
.00 __�__ � �zs.ot
'�xtures @ $35.OQ i x $3'.
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THIS IS �1N APPLICA'f10N �OR A PF.RMIT-NO"I' VAI.ID UNTIL PKOCESSED
I hereby apply for a building permit and t 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 with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plans.
SIGNA"fURE OF APPLICAN'���� PRINT NAMF. � G � (? �ZCi^t �i/`� DA'I�E /— � � ^ � /
APPROVALINSNECTORSSIGNATURE llATE �
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977