P - 42267From: unknown Page: 1/1 Date: 8/23/2010 2:12:28 PM
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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
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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
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❑ 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
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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 � . ' /�. )..\
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U City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
'163-572-36Q4 FAX:763-5Q2-4977