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P - 37236Building MECHANICAL Permit No.: L' Inspections RESIDENTIAL APPLICATION Re�e"'ea By: �-�—��— �63-s�2-3604 CITY OF FRIDLEY Da�+��' ;. " � 763-502-4977 FAX EFF�cTIVE �-i-2o>> DATE S� I7 J J I YOUR E-MAIL ADDRESS �Z L7`J "�.i % f' 7rc S' SITE ADDRESS �-� ((� (fl'1'� jj�}ve N L THIS APPLICANT IS: �OWNER ❑CONTRACTOR PROPERTY NAME: �� e c�v� iv ctiq �( OWNERi ADDRESS: L� 1U �5��^ l�u� /�/[ CITY � �'t �\e y STATE I�V�ZIP 5s'�� TENANT pHONE: "j� 3� 5� �-765 U CONTRACTOR COMPANY NAME. SUBMIT A COPY OF CONTACT PERSON: `JE' 1 f� YOUR STATE STATE LICENSE # EXP DATE LICENSE WITH qDDRESS: CITY STATE Z1P APPLICATION PHONE FAX PERMIT TYPE �INGLE FAMILY ❑ TWO FAMILY O TOWNHOUSE TYPE OF WORK: � NEW �REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK Rc �n I0.ce Ce �(: r�n Int��`�vnoc,,.� �� FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) PROVIDE HEAT (,OSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK. Equipment Installed MFG: MODEL: SIZE/BTU MFG: MODEL SIZE/BTU MFG: MODEL: S[ZE/BTU AfC $25.00 FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00 AIR TO AIR EXCHANGEER $ I S ^FIREPLACE (WOOD) $35.00 TiEW GAS GRILL $10.00 BOILER $35.00 FURNACE $35.00 GAS UNIT HTR $10.00 CHIMNEY LINER $10.00 ^GAS DRYER $10.00 POOL HEATER $35.00 _DUCT WOR1C $10.00 GAS PIPING $10.00 VENTILATOR $15.00 ; � ,� . �.�� .�.. . `�� ` . � �\ � �+¢� ��'�",,� i � ��R��a�� i�-�.'� �. � ��a.�� f�� y� �� ' � � . � . � l & � �'y s �i - '� s � � �,.,i �� . � �."" � �Ze "`h` ¢ �`y �5 i` .� �`�.�� " �� " �c e'✓a �..`�^��`��' �'�: ' � �� ,�: '�� C. � N � � ,� 3 � � �` �-� .� �+�' ��.�c �,�i'��"��`��-��r',. � �� z`�'�� `A+`� J,�� roao-:�E.�^�:T�,��rF '3' �'� '��ai�", a� '..� %'e y �k,�`�' '� � � �`%,�_t`� �' ''' Jr�S� � _ ��"��y'�. RS c � _ : �'�� a��'�'"` 4 a �� ::, �� k4 �r'��, � � `� � � ��,. � � � ., �' �,� � � �� , �� ,� af�'�.� ��, �a .�'�� :. �'�C'��i �' � ; � ��" �'� ��,�j x� ��-� � s� �� a �/� � .�'� �� x � - � � � � �, �� 3�t �� i�� x �� ,� �s � �, � ,-� � . .� � � ' � � ,s� �' '� v� �� '= � � G �" r� � � � � r � � � �� k� � �. �` � � �, ��Pv�E:��.�..� _. ��`��'��eg� ,� : �� y� � �z� � � F_ � '�*�, 7 14� , ,�^,�� yl��$ .. � `� �� €� � `` ✓�i� �� `' : �'�"g � f s '�- r� �, `x''� a ;a � � � � � � :,� � a �, �z '�"�. � «� � y . c��'��t�� <�� C��z �� `y� � � � ��} � � `� a � � � f � ��a � � �� £ ��}�aw�, S �� `�,,��"'� �` � � �'.�.'��,��s� '� � � . �'"�e �c. �� a'N�, a �y. � � _ � E � �, : � �t � � � ��: . �� : ,� �' � � . � � ��i� �� '' � � � `� � ,� �< �t .' � h .� � �' � � .�-..a '� �,.. ;;.z� -, ,..x � � �" s2.f�` � �� , � � ,,., w _ . . ... .. .::. .... . < , �. � • „ ., � ' ,: . �-,. ..�.,. . . �: . �.. .. . . . , _.. .. • .:,., „ � � , . s �; THIS IS AN APPLICATION FOR A PERMIT-NOT VALID LJNTIL PROCESSED I hereby appiy for a building permit and I acknowledge that the information above is compiete 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 case of all work which requires review and approval of plans. SIGNATUREOFAPPLICANT� PRINTNAME Je0.t� NLIU<I DATE ��17(/� APPROVAL INSPECTORS SIGNATURE DATE �.� ��.. . , '�"��'3��fi ... ,'�'��.1i�'�� . ,�t�,`7�! �5�1� $��3��Nt'".�r; Ei,.��"�'R��, �#.� "1��I�.��.�i� �t�?f;? ....,, ��. �,`: City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: ?63-502-4977