P - 44457Building MECHANICAL Permit No.: � � 4t
Inspections RESIDENTIAL APPLICATION Received By: A OV"\ �l
763-572-3604 � Rec'd: � � �
763-502-4977 FAX CITY OF FRIDLEY �� -
EFFECTIVE 2-19-09
DATE e� O/ YOUR E-MAIL ADDRESS
SITE ADDRESS �% I � 7'— PI
THIS APPLICANT IS: ❑ OWNER j�CONTRACTOR
PROPERTY NAME: �G�C�r f' S � •� �CPM �S
OWNER/ pDDRESS: CITY STATE ZIP
TENANT pxoNE: �i�l� 1��,(0 - O �p3
CONTRACTOR COMPANY NAME: f{oa,n►t $ Neme Tech�ol09ie8� 111C• '
SUBMIT A COPY OF CONTACT PERSON: dba Fireside Hearth & Home
YOUR STATE STATE LICENSE # EXP DATE 2700 N. Fairview Ave.
LICENSE WITH qDDRESS: CIT�Ssevi�llTe�� �i3
APPLICATION 1�-��B1 STATE ZIP
PHONE FAX
PERMIT TYPE �SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK• � NEW ❑ REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK j o�� �t� � � ��s � � �' C ,A �� G �' � � �s I : � � - -
`FEES.kRE BA'�ED UN 510.00 PER FIXTE�TRE, EXGEPT WHERE'NOTED: FIXTURES: (INDICATE TOTAL NUMBER OF EA�H'$�tAI�'� :- ;'. `:' "
. . �-,
:FRQYIDE HEAT LOSS CALC'S PER 11�A�iU#L 2006 AS E HANDBOOK. _ .: N� ' �-`�•
Equipment Installed MFG: � % �+ MODEL: L � O a- "'�IQ � • SIZE/BTU � \
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MFG: MODEL: S1ZE/BTU
MFG: MODEL: SIZEBTU
_A/C $25.00 FIREPLACE (GAS) S I 5.00 _GAS RANG�JOVEN $J O 00
_AiR�TQ AIR EXCHANGEER $15 , _FIREPLACE{WOOD) $35:00 NEW GAS GRILL $t4i.�AfM . ' ":
BOILER $35.00 FURNACE $35.00 _GAS UNIT HTR $10.00�:..
GHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATE�t $35;t?0 •� �
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 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
approvea plan in the case of all wo c which requires review and approval of plans.
SIGNATURE OF APPLICANT --' PRINT NAME K�'tIf /� /' /'i 4�. �.° DATE D
APPROVAL INSPECTORS SIGNATURE DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977