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P - 37145�. -����s Building MECIiANIC:AL PermitNo.�VO b�U,�� Inspections RESIDENTIAL APPLICATION Received By:�_ 763-572-3604 CITY OF FRIDLEY R��C��'� ,��� 763-502-4977 FAX EFFECTIVE 7-1-2010 DATE YOUR E-MAIL ADDRESS SITEADDRESS l,�t'15 -�ltat.Kzer i�1a.Ge- THIS APPLICANT I5: ❑ OWNER L9�ONTRACTOR PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE TYPE OF WORK: NAME: PHONE: COMPANY NAME:J CONTACT PERSON: STATE LICENSE # PHONE�%(e.3' tJ'.� �d(4(p'l FAX �NGLE FAMILY ❑ TWO FAMILY ❑ NEW �EPLACEMENT DETAILED DESCRIPTION OF WORK CITY -�Y' L d�CJld STATE EXP DA'['E �_CITY�'� 7la 3- 53L - � ❑ TOWNHOUSE � ALTERATION/REMODEL TATE /i'��IP � FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOIC. EquipmentInstalled MFG: C,;w►�tk MODEL: 7 M��$��� SIZE/BTU �v>°i" MFG: � N�� MODEL: X�- I'l — � 30 MFG: MODEL: 7i A/C $25.00 FIREPLACE (GAS) $15.00 AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 BOILER $35.00 k FURNACE $35.00 CHIMNEY LINER$10.00 GAS DRYER $10.00 _DUCT WORK $10.00 GAS PIPING $10.00 SIZE/BTU ���✓ SIZE/BTU 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 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 confotmance 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 which requires review and approval of plans. SIGNATURE OF APPLICANT �j ".Q�G`� ���^�.. PRINT NAME IC�-(� �;A�.✓�-1 N DATE I Z /6� o APPROVAL INSPECTORS SIGNATURE DATF. City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977