P - 46281Building MECHANICAL Permit No.: �d (
Inspections RESIDENTIAL APPLICATION Received By: �'�_
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�63-s�2-3604 CITY OF FRIDLEY ���:�L�-2-g—�
7b3-502-4977 FAX EF�ECTTV� i-i-aoii
DATE !v-Iq- i► YOURE-MAILADDRESS q�U4d.�.P,�,�,,�� r Ioe.,,� q�..a,f �. P w.,�
3TI'E ADDRESS J��'I3 Z S^ � S"� •/�•�t
THIS APPLICANT IS: ❑ OWNER ON"PRACTOR
PROPERTY N�: 5�(..V¢} �� O� A 42 J✓1 �
OWNER/ ADDRESS: CITY STATE ZIl'
TENANT
PHONE:
co�cTOR COMPANY NAME: f's QO U G �E �Z E�f� t..� � �..c-� �nQ c,���- s��
SUBMIT A COPY OF CONTACT PERSON: � 1 M �T �� F� �
YOUR STATE STATE LICENSE # �_��� - P�"i EXP DATE % Z�i" ��
LICENSE WITH �DRESS: l���13 i i��"�l-,� n1c.c, CITY,(�grti $� STATE�LIP�
APPLICATION PHONE `7tp'3 —'3 (���q� c� FAX 4
PERMIT TYPE � SINGLE FAMII,Y ❑ TWO FAMILY TOWNHOUSB
TYPE OF WORK: d NEw D REPLACBMENT �ALTERATIODI/REMODEL
DETAILED DESCRIl'TION OF WORK �_ o I�,ea�- s�.` I; e� �-- t� n,e_ =Re,�v r»tA.3 r
FEES ARE BASED ON 510.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURE3: (INDICATE TOTAL NUMBER OF EACH BELOR�
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK
Equipment tnstalled MFG: MODII.: SIZF✓BT[I
MFG: MODEL: SIZEJSTU
MFG: MODEL: SIZFJBT[J
�A/C $25.00 FIREPLACE (GAS) $15.00 GAS RANGFiOVEN �I0.00
_AIR TO AIR EXCHANGEER $15 FIREPLACB (WOQD) $35_00 NEW GAS GRII,LS10.00
�BOILER $35.00 _FURNACE $35.00 ,_GAS UIVIT H1R $10.00
HIl�4NEY LII3ER $10.00 GAS DRYER $10.00 ,1'OOL HEATER $35.00
UCT WORK $10.00 GAS PIPII�iG $10.00 VENTII,ATOR $15.00
� Q��t� � ���}:� �C �� i;�:� � �r'.�:;..,�,.,:'
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�l'tttntb�r t��:�ct1�r�,�.�l�:t�? `` x �I� {�! �� � : �. � . � � � � � `� " � �. � �
l�utn�r �f �ixtur�s (cz� �25.1�U x $25.#}i} - $
Numb�' affi�uares � �35.FH1 x �35.00 = $
�#ate Stu�ha�r�� = � . S.tl+� .�"'
�EE � OD Tot�l � $
THIS 1S AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a buiiding permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and des of the City of Fridley and with the Minnesota Cons�uction Codes; that I understand this is
not a permit but only an applicaf fs�t a pernut 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 c r uire review and approval of pians.
SIGNATURE OF APPLICANT � PRINT NAME DATE f �� V I
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APPROVAL INSPECTORS SIGNA DATE
' `�'�.•�, `S�'��E, �l:*�A�'� P��I��� ,�� �1�L'$�T��+��.�L.E���� �� 3��`�;c�1�� `��; `.
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977