P - 45299Building
Inspections
763-572-3604
763-502-4977 FAX
DATE / � � ` � (
SITE ADDRESS Z� �
THIS APPLICANT IS:
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFF,CTIV� 1-1-20] 1
YOUR E-MAIL ADDRESS
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❑ OWNER CgC'ONTRACTOR
PROPERTY NAME: _) d� ,� c.� '1� �y �,• �
TO NANT ADDRESS: 2Z 1 �j t�� ./t ��
PHONE: i7 i Z—' 1� I_%� S�
Permit No.:�
Received By:j�
Date '
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C7TY ��(� ,- � L y STATE�ZIP
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CONTRACTOR cOMPAt�v NAME:
SUBMIT A COPY OF CONTACT PF,RSON: RE�1Q�m11 6IB�6. H%f9f �� � FAIA� ���0'.
YOUR STATE STATE LICENSE # °� �'�� �� t�1$� �iA�� A
LICENSE WITH ADDRF,SS: F1AIl9 L1t�1I9� �A� ��� STATE ZIP
APPLICATiON '-`�`�`
PHONE /Q� �'��,��� _
PERMIT TYPE �INGLE FAM[LY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:. � NEW f{�REPLACEMENT O ALTERATION/REMODEL
DETAILED DESCRIPTTON OF WORK �� ��.,�� e� .. C. � vc C� �� _�� S 7C C� 1 3G Z�
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FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVI�
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 SHRAE HANDBOOK.
Equipment Installed MFG: + ...� MODEL: �j �j �E/'� i 3UZ� SIZEBTU 2- O V V
�A/C $25.00
AIR TO AIR EXCHANGEER $15
BOILER $35.00
CHIMNEY LINER $10.00
DUCT VJORK $10.00
I hereby appiy fdr a'building �
conformance with the ordinanc
not a permit but only an applic
approved plan in the case of all
SIGNATURE OF APPLICANT
APPROVAL[NSPECTORS
MFG:
MODEL:
MFG: MODEL:
FIREPLACE (GAS) $15.00
FIREPLACE (WOOD) $35.00
FURNACE $35.00
GAS DRYER $10.00
GAS PIPING $ ] 0.00
SIZElBTU
SIZEBTU
GAS RANGE/OVEN $]0.00
NEW GAS GRILL $10.00
GAS UNTT HTR $10.00
POOL HEATER $35.00
VENTILATOR $15.00
[S AN APPLICATION POR A PERMIT-NOT VALID UNTSL PROCESSfiD
and I �
d codes
for a pe
which)
iat the information above is complete and accurate; that the work will be in
Fridley and with the Minnesota Construction Codes; that I understand this is
is not to start without a permit; that the work will be in accordance with the
� and approval of plans.
�
DA
�1 City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
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