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P - 48320Building MECHANICAL Inspections RESIDENTIAL APPLICATION 763-572-3604 CITY OF FRIDLEY 763-502-4977 FAX EFFEC�r►vE �-�-2oi2 DATE_ ��/ �(J� YOUR E-MAIL/�ADDRESS s z . � SITE ADDRESS ��/ � y' I C_ /��� J j" /V � THIS APPLICANT IS: ❑ OWNER �CONTRACTOR Permit No.: '� ��I�! l; � � Received By: % Date Rec' • � � L ��c��;�� ►� PROPERTY NAME: OWNER/ ADDRESS: CITY STATE ZIP TENANT PHONE: � �� " �l��� -- ��G / CONTRACTOR COMPANY NAME: -/ 2✓'/ G� SUBMIT A COPY OF CONTACT PERSON: _,�/'j///'�/'...-✓) YOUR STATE STATE LICENSE # EXP DATE LICENSE WITH ADDRESS: , CITY /�7�1-iyt L�F�� �. STAT@'l�ZIP�(L`� APPLICATION pHONE / — � ' FAX S �e�1r PERMIT TYPE TYPE OF WORK: DETAILED O SINGLE FAMILY f�TWO FAMILY ❑ NEW ❑ REPLACEMENT � � • �_, ❑ TOWNHOUSE �ALTERATION/FtEMODEL ��� r +2 FEES ARE BASED ON �10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK. Equipment Installed MFG: MODEL: SIZEBTU MFG: MODEL: SIZEBTU MFG: MODEL: SIZEBTU A/C $25.00 FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00 AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00 BOILER $35.00 FURNACE $35.00 GAS UNIT HTR $] 0.00 CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00 llUC'I «�ORK $10 00 GAS PIPING $10.00 VENTILATOR $75.00 �Iu�iiber affixtures �(c� $i0.0'0 - x $I(}.0� $ � uml :00—$ TH1S 1S AN APPLICATION FOR A YERMIT-NOT VAL1D 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 onlyJaa_.a ' tion for a ' nd work is not to start without a ermit; that the work will be in accordance with the approved plan�case of all wor ic r ' es r view and approval of pla . SIGNATURE OF A 'tCt1NT - - -- PR1NT NA f� �d�! � DATE � � �'� � 2 APPROVAL INSPECTORS SIGNATU DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977