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P - 42267From: unknown Page: 1/1 Date: 8/23/2010 2:12:28 PM ....b �... �.. ...�. � .1_ f� Building MECHANICAL Permit No.:z..� � � � Inspections RESIDENTIAL APPLICATION Receivea By: ' 7b3-572-3604 CITY OF FRIDLEY ���' 0 763-502-4977 FAX F.cFFr^r�v�.�_i_�n�n SITE ADDRESS � 1'H[S APPL[CANT IS: OWNER/ TENANT ❑ OWNER ,�CONI'RACTOR �,�' V!Q N � ccrsr F �, � � � CONTRACTOR COMPANY NAMG: � � SUBMIT A COPY �F CONTACT PERSON: �� YOUR STATE STATB LICENSE � (�� L� 1-�"1 G�j"Y] EXP DATE LICENSE WCTH ADDRESS: �i r�,'� � 2h�CJ I A'j�P i1l.�CiTY S' ,�nPLtcAnorr pHONE 7(n3-�7/ -� L-�..5� Fnx z�3 -� �FaS'- 7N� / PERNIIT 1'YPE �SINGLE FAMILY Cl TWO FAI�LY TYrE oF wolt�c: �x�w ❑ xErLncan�e�vr DETAILED DESCRIPTION OF WORK ❑ �rowxxou5a ❑ ALTERATIONlREMODEL FEES ARE BASED ON 510.00 PER FIXT[TitE, EXCEPT Wi�RE NOTED. FIXTUR6S: (INDICATE TOTAL MTriSER OF EACH BBIA� PROVIDE REAt LOSS CALC'S PER 1NANUAL J 2006 ASHRA� HANDBOOK. Equipment lnstalled MF'G: MODEL: StZEJBTU MFG: MODEL: SIZFJBTU MFCi: MODEL: SiZFJBN A/C 325.OQ _,FIREPLACE (CiAS) SI 5.00 CA3 RANGFIOVEN 510.00 AiR TO AIR EXCHANGEER S15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL 510.00 BOfLERS35.00 FURNACE 535.00 ^GAS UNIT HTRS10.00 CHlMNEY LINER Si0;00 GAS DRYER $10.00 , TPOOL HEATER S35.00 DUCT WORK $10,00 _GAS PIPING 510.00 �VENTILA'1'OR 515.00 Nwnbec of fixfi�re,s (a3 $i0.00 x $10.00 = $ Num6er of fixtures {� 515.00 x$15.00 =$ Number of fixtures � 525.00 x$25.00 =$ Number of fixhires ([� $35.00 x 535.00 �� Stau Sw�charge = $ S.UtI ,��� '����� sm[�KU�um� r��, sau.uus �rora� = a -zv,cj-- THIS iS AN AP!'LICATION FOR A PBRJvlIT NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclmowledge that the information above is cornplete and accurata; thaR the work wiil be in conformance with the ondinances and oodes of the City of Fridley and with the Minnesota Consfruction Codes; that I understand this is not a permit but only an applicatiion for a permit and work is not to start without a pe�mit; that the work wiIl be in acoordance witle the approved plan in the case of all work whi re ires vi ar approval of plans. SIGNATURE OF APPLICANT C PRINT NAME�1 �[��C w�!/ I r' DATE J � A.. I � . ' /�. )..\ ��17 U City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 '163-572-36Q4 FAX:763-5Q2-4977