P - 35067Building MECHANICAL Permit No.: �
Inspections RESIDENTIAL APPLICATION Received By:(
763-572-3604 ��� 2 � �
763-502-4977 FAX CITY OF FRIDLEY �at��[p:- ��
EFFECTI VE 7- ] -2010
DATE l�" o�-�.- ( u YO -MAIL ADDRESS
SITE ADDRESS �
TH1S APPL]CANT IS: ❑ OWNER �ONTRACTOR
PROPERTY NAME:� g—i21 � r.�, � K.r A��' �
TNNN� ADDRESS: �6J( �r��.�.✓ `�. � CITY ��-I�ItiY, STATE�"'��ZIPv�Y3'�
PHONE: ? �3 ' � ��'I , 331 1
CONTRACTOR COMPANY NAME: � v�, v � ln iI � e- �
SUBMIT A COPY OF CONTACT PERSON: C.� r c�� r N p
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH ADDRESS: A C� Q a 6� r� w � N l� CITY �a2.1 �( � STATEY-11� ZIP ���d Z
APPLICATION pHONE 7b-'-' "7 S Y__� I S y FAX
PERMTT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � NEW �REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK �✓1 Sk,t ( I �,p 10-�v7 �...�-� �t_.._ e_ ,��. :�
FEES ARE BASED ON 510.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELO�
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK.
Equipment Installed MFG: � - .�.� MODEL: 3 S JI,3 AV l� `� 10 � n SIZEBTU le 0 u U �
�
MFG: MODEL: SIZEBTU
MFG: MODEL: SIZEBTU
_A/C $25.00 FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00
_AIR TO AIR EXCHANGEER $IS FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
BOILER $35.00 �FURNACE $35.00 GAS LJNIT HTR $10.00
CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $] 0.00 VENTILATOR $15.00
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THIS IS 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 case of ali work which requires review and approval of plans.
SIGNATURE OF APPLICANT , �. 1 r PRINT NAME C r^ '� t J j2 DATE 1�' �� j e
APPROVAL INSPECTORS SIGNATURE ,, DATE
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Cityo uf Fridle_y
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977