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Inspections
763-572-3604
763-502-4977 FAX
DATE�
SITE ADDRESS _
THIS APPLICANT IS
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOURSTATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
NAME:
PHONE:
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2011
■•.►I:
COMPANY NAME:
CONTACTPERSON:
STATE LICENSE #
ADDRESS: v�
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_ YOUR E-MAIL ADDRESS
� FAX
SINGLE FAMILY ❑ TWO FAMILY
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❑ NEW ❑ REPLACEMENT
DETAILED DESCRII'TION OF WORK
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EXP DATE � C� �
CITY �
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❑ TOWNHOUSE
�ALTERATION/REMODEL
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Permit No.:'� U l %
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Received By: � � '
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FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOV�
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK
Equipment Installed MFG: MODEL: SIZEBTU
A/C $25.00
AIR TO AIR EXCHANGEER $15
BOILER $35.00
CHIMNEY LINER $10.00
�DUCT WORK $10.00
MFG:
MODEL:
MFG: MODEL:
FIREPLACE (GAS) $15.00
_FIREPLACE (WOOD) $35.00
_FURNACE $35.00
GAS DRYER $10.00
GAS PIPING $10.00
SIZEBTU
SIZEBTU
GAS RANGE/OVEN $10.00
NEW GAS GRILL $10.00
GAS UNIT HTR $10.00
POOL HEATER $35.00
VENTILATOR $15.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID lIN1'IL 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 all work wh'c •equires review and approval of p s.
SIGNATUREOFAPPLICANT � �V �'VV�-K�i�1'1 ivAME `� W�Ci � Ili�� 1V��/"`.v� DATE
APPROVAL INSPECTORS SIGNATURE DATE __
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977