P - 35277Building
Inspections
763-572-3604
763-502-4977 FAX
DATE � � /
SITE ADDRESS
THIS APPLICANT IS
PROPERTY
OWNER/
TENANT
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
_ _ EFFECTIVE 7-I-2010
❑ OWNER
ADDRESS
Permit No.: � � � ��•� �-
,
Received By: ,�}: ?
Date Rec'd:
I�C'b .I U� 011
A
CONTRACTOR COMPANY NAME: ��R HEATING & A. C.
SUBMIT A COPY OF CONTACT PERSON: FLOYD JOSWICR
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH ,e,pD�ss:7221 �University Ave. N E CITY FT1C112y STATEMN ZIP 55432
APPLICATION pHONE 763-572-0459 F,ax?63-572-0164 �
PERMIT TYPE
TYPE OF WORK:
�MGLE FAMILY
❑ NEW
DETAILED DESCRII'TION OF WORK
O TWO FAMILY
REPLACEMENT
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
FEES ARE BASED ON S10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVi�.
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK.
Equipment Installed MFG: �— MODEL: SIZEBTU
MFG: ��F�— MODBL: �.��
SIZE/BTU --�
MFG: MODEL: SIZEBTU
�A1C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL 510.00
_BOILER $35.00 FURNACE $35.00 _GAS UNIT HTR $10.00
CHIMTdEY LINER $10.40 _GAS DRYER $10.00 POOL HEATER $35.00
_DUCT WORK $10.00 _GAS PIPMG $]0.00 VENTILATOR $15.00
�.� _ ._
_ _ ......_.
IS IS AN APPLICATION FOR A PERMIT-NOT VALTD 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
conformance 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 ap ication for a pezmit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of 11 work wl�ic� re�es review and approval of plan�, �,�
SIGNATURE OF APPLICANT
APPTtaVAL INSPECTORS
!`►1
DATE �
� City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
+�DATE_ ^ � "
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