P - 36951, „ , , ��. ��,_ _ � . ��, , , , ,�,. , �` From;�952-941 ;1967 � Pa�e: 2/8 _ _ Date: 4/25/2011 8:34:24 AMv` y `
Building
Tnspections
763-572-3604
763-502-4977 FAX
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S1TE ADDRESS
THIS APPLICANI' IS:
OWNER!
TENANT
SUBMIT A COPY OF
YOURSTATE
UicsNSS warH
APP�ICAT{ON
MECHANICAL pe�,�t No.:-�
RESIDENTIAL APPLICATIUN Received By:�
CTTY OF FRIDLEY ��� �
_ EFFECTIV& I-I-201I
O OWI�(ER �
NAM6;,,.,, t
ADDRFSS:����
PHqNE:--,�l�#L�G
COMPANY NAME:��
CUNTACT PERSON: �
5TA7'E LICENS� Il
ADDRESS: 7 -C�i.Z�
PHONE QS�� •'�./ �!—
YOUR E-MAII. ADDRGSS
PERMIT 7'1'PE �SINGLB FAMtLY Q TWO FAMELY
TYPE QF WORK: � N�w p.REPI.ACEMENT
DETA[1,ED DESCRIPTION OF WORK
P,
EXP DATE
�,�,� �� �C�!TY `/-I/tl�� STATE�ZIP_���7`T
FAX _ __ `i5r.�14dt — JQ1'n7
❑ TOWNHOUSE
0 ALT6RATION/RFM4DEL
FEI?S ARE BASED ON SI0.00 PE[t F1X7'URB, EXCEPT WH�tt� lV(YfEU. FIXTURFS: QNDICATE TOTAI., Ni)MBER OF EACH BELOVI�
PROVEDE HL�AT tASS CALC'3 N�R MANUAL d 2006 ASHRAE NANDBOOK.
Equipment Instailed MFG; �',� MODEL: 8 SIZElf3TU _a���yr�
�
MFG: MODEL: SIZE/BTU
MFG: MODEL; g{��g�
A/G $25.00 FIftEP1.ACE (GA5) $I S.UU �GAS RANGF10V6N St0.00
„�AIR TO A1R EXCHANGEER S15 FTREPL,ACE (WOOD) S3S.00 N£W GAS CRILL $10.00
BOILER $35.00 �FURNAC6 535.00 �GAS UNIT HTR $10.U0
`CIfIMNEY LIIJER S10.W GAS DRYER S10.00 POOL. HEAT6R S3S.00
DUCT WORK a10.00 GAS PIPINC $1000 _`VENTILATOR 515.00
�., X �lU.00 � 5�,,..�,.�
��b�roff`tXtu�s (� �aS,QO,�.. �;,,, � $lS.t�Q � ��__,.�..,,.
rluritkerA�lixEUrGS (� $��..00 � � �2.S.Q0 � ��---.,_
��bcr t�f f,r�k�r� (t� $35A0: ,:,,�,,,, �, .533:00 �+ �,�;�
a`ttt� �����'R7�= . ... '++:.:+�.+���..�
+
LICATtON FOR A PERMIT-NOT VALID UNTIL PRQC�SSED
C hereby apply for a building parmit and 1 acknowledge that the information above is camplete and aocurate; that the work wiil be in
conformance with thc ordinances ar�d code of the Cily of Fridley and with the Minnesota Construction Codes; that t understand this is
not a permit but only an applicati for a 't and work is ot to start without a permit; that the woric will be in xccordfu►ce with the
approved plan in the case of alt k i qu s revie d approval of plans. /� /
SiGTiA1'URE OF AAPLICANT ���IJiSf� au n,rr �� e s�v �/i/.�l �/Q.a N�dP. .. J,. ��l /�/
� City of Fridley
' ding Inspections Department
643 University Avenue NE, Fridley, MN 55432
763-572-3504 FAX: 763-502-4977