P - 42754Building ��i �;������� Permit No.?�
Inspections �, ����,��'�� ,����„���'�'��� Received By:�_
763-572-3604 ���� �� ������ � �at��-�d
763-502-4977 FAX �' .. �
EFFECTIVL 7- i -2010
DATE �<�- f 5— r r� YOUR $-MAIL ADDRESS
SITEADDRESS ��� �' �ri�� JQ'l;. ��= j=�y3i�,l.� ���-' 'j.('ii�3�
THIS APPLICANT IS: ❑ OWNER �CONTRAC�'OR
PROPERTY NaME: �/a u� �.-; ;�, r�a.��r1�
ENNAN� ADDRESS: •� �� "J `( f� tQ+��, t� = CITY FH= r� te . STATE!"��" ZIP � ���,��
PHON�: �l(,-� • J 7�.- : (,l.V V
CONTRACTOR COMPANY NAME: I�'��-� v•- � C_', ��, J��� t c f �'? t�-r I
SUBMIT A COPY OF CONTACT PERSON: L� �����F'
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH ADDRESS: �� `i � �'i � � ^ Ji �`'' `� CITY F� I �!l �. STATE�� ZIP � � �� 32
APPLICATION pHONE '7 t> s-1 S`{ �� : 4 r7 FAX
PERMIT TYPE �SINGLE FAMILY ❑ TWO FAMILY -❑ TOWNHOUSE
TYPE OF WORK: � NEW '�`REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK T+^� �> �: � J �'� L ,� ( �,. , , � ._ ��- �� rz. � �c �-� � � r n L a r, r,( i � � sn � �
FEES ARE BASED ON 510.00 PER FIXT[TRE; EXCEPT WHERE NOTED. FIXTURES: (IIVDICATE TOTAL NUMBER OF EACH BELOVI�
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK.
Equipment Installed MFG: [,,. r�e. �:•c— MODEL: 5���v �' �� ��' " i�/ SIZE/B1'iJ D, U d �
MFG: C� e_ K a«. �•.•. MODEL: a`/ �4 e� A 5�7. �! g�Etg�i1 '�Ti, i1
MFG: MODEL: SIZEBTII
xA/C $25.00 FIREPLACE (GAS} $I5,00 GAS RANGE/OVEN $10.00
_AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
BOILER $35.00 � FURNACE $35.00 GAS LJNIT HTR $10.00
_CHIMNEY LINER $10.00 _GAS DRYER $10.00 ,POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
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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 compiete 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.
SIGNATURE OF APPLICANT �� � �^' "�`r' ��� ��c_:• j > PRINT NAME � �^ '" �' �� �` �'� DATE �� " ��-�"- , ��,
APPROVAL INSPECTORS SIGNATURE DATE
`, 'PLEASE NO.'TE: � S�P�IR:ATE PE1�ItfFI7'�,�RE REQUTF�EL� �'�R BLII.�DIN�;:ELEC`I'RTG�.L PiND.I�]EC�:fANiCA�; `Wf3RK '
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 5�432
763-572-3604 FAX: 763-502-4977