P - 35811Building
Inspections
763-572-3604
763-502-4977 FAX
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
DATE i` �' ������� `� YOUR &MAIL � DRESS
SITEADDRESS �Zj ��� �, ��t,,, � iCi,�' ( �[L1 �`�.__� i
THIS APPLICANT IS: ❑ OWNER 1.I�ONTRACTOR
Permit No.'.
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PROPERTY �A�:���'� }��-.�
OWNER/ ADDx�ss: �'-�OI,I�Y� �� CITY STATE ZIP
TENANT
PHQNE:
CONTRACTOR � CoivrnnrrY
�
SUBMIT A COPY OF CONTACT PERSON: � C l�•(�- S� ��y� v
YOUR STATE STATE LICENSE # BXP DATE
LICENSE WITH ADDRESS: ,�T1�,'�J \ IInC�� �� CITY '��STATE,�1Zg�,��
APPLICATION pHONE�I Il�, �� C�,(��_ FAX
PERMIT TYPE �INC�LE FAMILY ❑ TWO FAMILY
TYPE OF WORK: I� NEW '�EPLACEMENP
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK c�Q ,r� Q Q 1"�,g�,r ��_ ��,�i'�,�Yi�Q/r
FEES ARE BASED ON SI0.00 PER FIXTLIRE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH $ELOR�
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 SHRAE AANDBOOK.
Equipment Installed MFG: —��a.)-� MODEL: � SIZ TU
MFG; MODEL: SIZEBTU
MFG: MODEL: SIZFBTU
�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 iJNIT HTR $10.00
_CHIMNEY LINER $10.00 _GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
I hereby apply for a t
conformance with the
not a permit but on
approved plan in e c
SIGNATURE OF
AL
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
nit and I acknowledge that the information above is complete and accurate; that the work will be in
and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
�n for a per ' iand work is not to start without a permit; that the work will be in accordance with the
>rk which requ s rev}ew and approval of plans.
��/�/
City of Fridley
�uilding Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977