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P - 42238Building Inspections 763-572-3604 763-502-4977 FAX DATE �/ I b� � ( � SITE ADDRESS 3� � THIS APPLICANT IS: PROPERTY � OWNER/ TENANT MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 7-1-2010 .. : � �. YOUR E-MAIL ADDRESS WC�.� O� ❑CONTRACTOR (� yN 'vl✓� Q% 33 �. !o � G���/ tG3�5�� -�i�g 2 Permit No ��% � � �} � � Received By:������� D�ie��e�� G 1 s 2 0 � n �� A CONTRACTOR COMPANY NAME: SUBMIT A COPY OF CONTACT PERSQN: YOUR STATE STATE LICENSE �! EXP DATE LICENSE WITH qDDRESS: CITY STATE ZII' APPLICATION pHONE FAX PERMIT TYPE TYPE OF WORK: 6�SINGLE FAMILY O TWO FAMILY ❑ NEW ❑ REPLACEMENT DETAILED DESCRIPTION OF WORK ❑ TOWNHOUSE �AL,TERATION/REMODEL �.� FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) PROVIDE HEAT LOSS CALC'S PER MANUA J 2I�006 A�RAE HANDBOOK. Equipment Instatled MFG: A �� MODEL: 5�� � SIZE/BTU MFG: MODEL: SIZEBTU MFG: MODEL: SIZE/BTU _A/C $25.00 �IREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 AIIt TO AIR EXCHANGEER $15 FIREPLACE (WOOD) 535.00 NEW GAS GRILL 510.00 BOILER $35.00 FURNACE $35.00 GAS UNIT HTR $10.00 _CHIIvIIdEY LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00 _ DUCT WORK $10.00 GAS PIPING $10.00 _VENTILATOR $15.00 THIS IS AN APPLICATION FOR A PERMIT-NdT 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 applicati o a p it work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work , Yyic quir review and approval of plan �..-- , J G SIGNATURE OF APPLICAN PRINT NAME�� �J u� � DATE O l� Z��� APPROVAL INSPECTORS SIGNATURE DA City of Fridley Building Inspections Department 6431 University Avenue NE, Fridiey, MN 55432 763-572-3604 FAX: 763-502-4977.