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P - 35059Building MECHANICAL Inspections RESIDENTIAL APPLICATION �63-572-3604 CITY OF FRIDLEY 763-502-4977 FAX _ EFFECT�vE �-�-ZO>> ,., DATE � / o[ - � SITE ADDRESS � THIS APPLICANT IS: PROPERTY N OWNER/ A TENANT ❑ OWNER YOUR E-MAIL CITY Permit No.: Received By: Date��i:� A CONTRACTOR COMPANY NAME: �-t � r SUBMIT A COPY OF CONTACT PERSON: r-.r t.�� /l/� G��� �� � YOUR STATE � STATE LICENSE # EXP DATE LICENSE WITH ADDRESS: L` c CITY y�L�% � STATE�ZIP APPLICATION PHONE D FAX PERMIT TYPE TYPE OF WORK: FAMILY ❑ TWO FAMILY ❑ NEW O REPLACEMENT DETAILED DESCRIPTION OF WORK ❑ TOWNHOUSE TERATION/REMODEL � FEES ARE BASED ON $]0.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: ([NDICATE TOTAL NUMBER OF EACH BELOW) PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK. Equipment Installed MFG: MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU 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 $10.00 CHIMNEY LINER $10.00 GAS DRYER $10.00 �P'�OO:L HEATER $35.00 _DUCT WORK $] 0.00 _GAS PiPING $10.00 Xv tNTI LATOR $ I 5.00 TH1S IS AN APPLICATION FOR NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowled he infor ation above is complete and accurate; that the work will be in conformance with the ordinances and codes of the ' .cidley a with the Minnesota Construction Codes; that I understand this is not a permit but only an applicatio rm a d is not start without a permit; that t6e work will be in accordance with the approved plan in the case of � �r�ir view an approval of plans. , f , SIGNATURE OF APPROVAL TURE PRINT NA DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 r 11