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P - 41803Building Inspections 763-572-3604 763-502-4977 FAX DATE ,_� - � � ^ i % SITE ADDRESS J �o THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE NAME: MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE ]-1-20] 1 ❑ OWNER YOUR E-MAIL ADDRESS PHONE: % �D 3 ,�� �4 Co�s,� COMPANY NAME: CONTACT PERSON: 0 CITY Permit No.: Received By: 1�'�'� Date Rec'd: `�`� �(� � � � TATE�Z[P� STATE LICENSE # EXP DATE ADDRESS: 1�5�� ��� d� CITY rn. (s. STATEI�'��ZIP��g PHONE?G � — � �� �.7 � FAX FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: � NEW '�LEPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK � �„ �/ �, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) PROVIDE HEAT LOSS CALC'S PER MANii� J 2006 E HANDBOOK. 1� Equipment Installed MFG:e�S i MODEL: I U�F#1 S1ZE/BTU � MFG: �� `� MODEL: 1� 3 14 ►.�A SIZE/B?U ,..�, D�..J MFG: MODEL: �A/C $25.00 FIREPLACE (GAS) $15.00 AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 BOILER $35.00 FURNACE $35.00 CHIMNEY LINER $10.00 �AS DRYER $10.00 DUCT WORK $]0.00 GAS PIP[NG $10.00 SIZE/BN GAS RANGE/OVEN $10.00 NEW GAS GRILL $10.00 _GAS UNIT HTR $10.00 POOL HEATER $35.00 �V ENTiLATOR $15.00 AN APPLICATION FOR A PERMIT-NOT 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 application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the�ase�- 1 wo_r� ' h qu' es review and approval e€�{�l n�..s�.�� ase- SIGNATURE OF APPLICANT PRINT NAME l� h^ �1,.L11�d` S DATE �'� I�� 1� APPROVALINSPECTORSSIGNATURE DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977