P - 45693� �„ � � `� �_ _., y,,, From:, 6517773252 Page: 216 Date: 10/25/2011 1:49:06 PM
Building MECHANICAL
Inspections RE�IDENTIAL APPLICATICIN
�763-572-3604 �ITy pF FRIDLEY
7b3-502-4977 FAX �czTVE ia.2oti
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sr.t� AnDCtES s 7 3 ch � 1-1 Q1
THIS APPLICANT IS: Q
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Permit No.:.
Received By:
�' 1'��' 1'.0 °�_■s.if:�..Y !I i?� i i�• a
�GC3!NTRACTOR
OWNERI I ADDRESS: CITY STATE ZII'
TLNANT
PHaNE:
SUBMIT A COPY pF CONTACT PERSON: �,] i a1l'1 �., -
YOLFR $TATE STATE LICENSE # EXI� DA7E
LIGEI+TSE WITH ADDRESS._�ZZQ C� e!"r/Q1� A'yG CITY QOf� STATF�ZIP���
APPLICATiON pHONE;��„'j'� '77 %. TCs i�O FAx �o ,J �• �l'7'%' � S Z•
PERMIT TYPE �SINGLE FAMILY o�rwo F�a�r
TYPE OF WORK: a �' ��PLACEIrfENT
DETAILED DESCRIPTIQN OF
❑ Towxxousfi
D ALT�RATIOIV/REM�DBL
FEES ARE BASED piH S1tI�QQ PER F�XTURE, EXCEPT WHLRE N�TED. FIXTUi3E9: (1NDICATE TQTAL NU1t�ER OF E!►CH BEI.O�
PROVIDE HEAT LOS9 CALC'S PER MANU J 2006 ASHRAB FIANDB�I£
�MPmem 1nsffilltd MFG: �T MODEL: � 5�l�_ SIZEB'RT .,�,Q�,QQ j�
A!C 525.00
EXCHANGEER $15
BOILIIt 535.00
CFIIMNEY LINER $ � 0.00
��DITCT tiVORK S 10.00
INF(3: MODII,:
MFG: MODEL:
FI1t�PLACE (GAS ) $15:00
�FIREPLACE (W(30D) 335.OQ
i �FURNACE $35.00
�GA3 DRYBR $10.00
_ _ _C AS PlPING Si 0.00
SIZEJBTU
SIZEJBI'U
_OAS RANf3EI�VEN $14.00
?iEW CiAS C3RILL$10.00
_GAS UNIT HTR 510.00
�P�OL HEA'TER $35.Q0 , , , .
TFIIS IS AN PPLICATION F R A P�I����3� �iQL�pRflCESSED
I hereby spply for a building permit and I ac the ' ion above is complete and accurabe; that the work will lx in
conformance with the ordinances and codes of the City ridley and with the M�inr►esata Construction Codes; that I understand this is
not a germit but anly an applica#ian for a permit and work is not to start w•ithout a permit; f3�at the work will be in sccordaace with the
approved plan in the case af all work which req�uir�s review and approval of plans.
� • � • r _ .
SIGNATURE OF APPLICANT
�.���City +�f Fridley
ding Inspections Department
b431 University Avenue NE, Fridley, MN 55432
?63-572-3604 FAX: 763-502-4977
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