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P - 42273Building Inspections 763-572-3604 763-502-4977 FAX DATE "1 ' �"'� " SITE ADDRESS � THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBNIIT A COPY OF YOURSTATE LICENSE WITH APPLICATION PERMIT TYPE TYPE OF WORK: MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTTVE I-1-2010 YOUR / ❑ OWNER +�CONTRA Y�C f Y l Q J j� S: �o % 2- �o �i' COMPANY NAME� CONTACT PERSON!�-Js� G STATE LICENSE #�� • � � ' '7fi�"Z"�_��'�1� �i:l� ♦ • � � �� - -_ - Q SINGLE FAMILY ❑ TWO FAMILY ❑ NEW - �'REPLACEMENT DETAII.ED DESCRIl'TION OF WORK EXP DATE ❑ TOWNHOUSE 0 ALTERATION/REMODEL Permit No. � - - . : �.� . �. ��� -� �� �; " 1 �i TATE ZIP FEES ARE BASED ON 510.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (IIYDICATE TOTAL NUMBER OF EACH BELOW) PROVIDE HEAT LOSS CALC'S FER MANUAL J 2006 ASHRAE IiANDBOOK. Equipment Installed MFG: MODEL: SIZEB'fU ���r� MFG: MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU A/C 525.00 _FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00 AIRTO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00 BOILER 535.00 FURNACE 535.00 GAS UNIT HTR $10.00 CHIMNEY LINER $10.00 _GAS DRYER $10.00 POOL HEATER $35.00 DUCT WORK 510.00 _GAS PIPING $10.00 _VENT[LATOR $15.00 THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNT[L 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 ermit and work is not to start without a per►nit; that the work will be in accordance with the approved plan in the case of all w ch requ' es e e and approval of plans. SIGNATURE OF APP�ICANT A�2�����/C_.� PRINT NAMEP/.^.��J Gt/Ll_!LU Y DATE "1 �� ALINSPECTORS City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977