P - 44841Building MECHANIC AL
Inspections '; RESIDENTIAL APPLICATICIN
�63-s�2-3�04 ' CITY OF FRIDLEY
7b3-�02-4977 FAX i Er t:EC.�eiti.E i-i-ZO� i
DATE � ..-
SITEADDRESS__ � �
THIS APPLICANT IS:
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PRQPERTY ; �q�1�.
OWIVER/ ADDRE:
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`'"'••`•^`�•"^ ! COMPANYNAME: �d15U11 f'IUIIIC3it1_y, 111(;,
su�3Mrr A coNY oN ! coNr,�c-r PERSOr,: Wendy NetSOn
YOUR SI'ATI: STATE LICENSE N rJ�%57 ��34� � EXP DATE
r.�ct;NSH v►�i�r�� ,�L,,,R�ss: 3095 162nd Lane NW C[TY" AndovBr STA7EMNZ�P 55304
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APP[.ica,���ior� ` �,H�,N� 763-427-76$0 }ax 7fi3�27-9448
PERMlT TYPE
TYPE OF WORK:
�SINt;LE FAMiLY ❑ TWO FALiILY
C] 1F.lV ❑ RF,PI.ACF.INENT
DCTAILCD bCSCRIP`t'[4N U�' WURK
❑ TOW`NHt7U5E
❑ AI_TF.RATIf)NIRF.YfOpF.t..
FEES ARE B.a.SED ()ti 510.00 PER F'LkTI'ItE, E?LCEPT i'�HERE'.VOTED. Ft�'iURES: (IhDICATE TtYI'AL NLip[$ER [}F EACH BELOW)
PR(34'iDE iiE.;T LOS� CALC'S P6R RI.4N(7At. J 2{IQb .�tiHRAE HANDBLX)K.
Equipmcn� {nstallcd h1F(i: N(C)DEL: 5lZF,lB71J
?4tE(i'
:�t()DET.:
SIZE/HTU
Mi�(i^ MODEL: SIZEBTU
AiC' SZ5,00 ��� �� FIREPLACE {QAS} $15.00 �GAS RANGElOVEN 510.00
AlR Tb AIR EXCHANGEER $15 FIREPLACE (WUC)D) S35.U0 2�EW GA5 CiRlLLS1q.00
B(i(LER S35.C(1 FURNACE $35.Q0 GAS INIT HTR $]0.00
�CH[MNEY LIVER 310.�0 G.45 DRYER $10.00 �POOL HEATER $35.00
_Dl:CT WC?RK 510,00 GAS PIPING St�.00 �VERIT(LAT[Nt SI5.00
TF[1S fS AN?�PFL1C'.fi7'If.�h E�iR?, PERNiIT-Nf3T i'ALID I.:n2iIL FRt]CESSED
t I�ereby a{�ply for a building pennit anci 1 acki�ewled�e that the infoiTnatia:� abar•e is cc�enplete and accurate,-, tliat the work will be in
conFormance with the orciinance4 and codes ofthe City of Fridley and «ith the Minnesota Construction Cc�des; that I understand this is
not a permit t�ut �n9y an appli ion for a permit and work is nat to start without a pen�it; that the wark wiif be in accordance with the
approved plan in the case of ork which "res rev9ew and apprr�vai of pl�ns,
StCi'VA�'17RF.('�FAPPI.fC',4 �PftiNT'ti.AviF.7K!'fu' T//�V ��✓J�� DATF. � �
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APPROVAL
Tl.� RE
DA
City of Fridley
liuilding lnspections Department
6431 L'niversity Avenue NE, Fridley, I41N 5543?
7G3-S72-3GC14 FAX: 7G3-Sa2-4977