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P - 48038Building MECHANICAL Permit No.: ` Inspections RESIDENTIAL APPLICATION Received By: � 763-572-3604 CITY OF FRIDLEY Date i:�� 763-502-4977 FAX EFFECTivE �-�-20> > � � DATE �Z - %- �� YOUR E-MAIL ADDRESS /,(l� • '��'°n , �yyj4/�r�i�I'"I SITE ADDRESS (>S�%S- �%Lv�2�� S� � THIS APPL(CANT IS: O OWNER �CONTRACTOR PROPERTY tvAME: ��. d- A„�4 �. �,+�•: � f;�....s TNANT ADDRESS: G5�lS I�Jc�✓i/yy �_ �� CITY Yr'�%�fY c STATE,�.�ZIP� PHONE: CONTRACTOR COMPANYNAME: ��I��q vr.br �- I�th�rv SUBMIT A COPY OF CONTACT PERSON: ��c, LQ `� YOUR STATE STATE LICENSE # EXP DATE LICENSE WITH ' c�. ADDRESS:�ap�G 14�$�� S�- ,(/fai CITY •,�s.ti �.,IG� STATE HI�ZIP� APPLICATION pHONE G/Z-%S%-SSja"i FAX��,�-��3-'loD�"7 PERMIT TYPE � SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: � NEw � REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK 1'ti�d,,,.,c�F f�,� %r�,,� 7v 2w..,�,� �',�J..r- �%r�, ,/J,�,,,.,`�, j�,,,<<„ti �,�.� ��r,� �n. iF�,��, �..<sk�s J� , __ 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 HANDBOOK. Equipment Installed MFG: MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU MFG: MODEL: ' SIZE/BTU _A/C $25.00 FIREPLACE (GAS) $15.00 � GAS RANGE/OVEN $10.00 _AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 _BOILER $35.00 FURNACE $35.00 GAS UNIT HTR $10.00 _CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00 _DUCT WORK $]0.00 _GAS PIPING $10.00 VENTILATOR $I5.00 � � ,�_ '�* . , �. � � � �. � �: �, �w � �` ��. �F y s � �: �. t'' �`1 � '�r � ° � �r,.�, =` ,, 'a� x�� ✓��'� � � `�y � �,� x $ ' � �,�: r° + _ a�`�ry��. �4'''h �' � ';. '�'� � rx �'� �� : j � ' � S � ,+ � � :.� f � � � '� �: .�'��- '� `� � ; � �,�^'/ ' �' �'�. � � � � �'�m .�..�.; � � x � - � � . -� �� t�� `� � '` � a . :. �� yM•.� � � � � � I � v�: �. .� �,� } �S ' y � � . � � � � � i � �, �. �i , _ �� a � C � �'�, .s �T 3`_s .�'�fi�i°� . � � 3 a � �,.,r-� c.�� :�c �.� � � � � � � � � , � � s � � �� : a'� �� ,� s'i �'�S� � � � .�` � ; ,� � r i �� ` .; �'��'� x� , t ,�v" ,� �. `��s� ��1�, .� : � a ,. � 3 �" , � � ��.s "� �� ' c�c 3' � �,. 'h��,� � , t�'4 3:� �,��` '�; � � � � � � r y � a �: "� "�� ' �� ,�,�� s �+ 3 a�„ L i��, � K?<. '.. r.s � � �;F x,��'3 3 ay t t � n� +� - �.\ .i, `� 3 ,�"..:. ` �` ' ? � <ri � ��` � r � � �, r �� . � i, � � C " . y � 1' � � .,��'t�«` '� � � r,� ;g; '� - y __ y� , r -a `v� bA" F �' �� f � � � ��' �� ._ � -- � ,� ,�< a "_ c ",:g� A '�'y�` �'.�'�:�- u�� s z : � �� e,w : �° � .�, � � , -"' , f . � � .. `,� ,, � z �, � � .n, q � ; � g �j�j `�..`� � _ ila a ., �� _ � � T 3 �r� � � a `�`?- r � � �..� � � '�, � �r£ �v�,�,�. :: ��R�z?,� ��. � �, i �'��,�,�� x t��,� �� { �� es. s�h ;�- � � 1 i" rs a � -L � '�-� r'�v . i a �` � c� � �� ,w? � : �'�� T � � � �� , �v �� . _ ,..< _ ,.. . - ,. , , �,.:- .. . .. .,,,,: .,,,,; . � ' a� s.. ,� , �. �`'�'• n � ✓ �� _ � � � � . .. :., .,.r. ..:,,. .,... ...��. ... , ,,. . .,. -< ' � ....,�,�t� . ,....,,��,�` �:. �£ . --- THIS IS AN APPLICATION FOR A PERMIT-NOT VAL[D 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 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 require review proval of plans. SIGNATURE OF APPLIC�� - PRINT NAME��-,�/�`�� DATE IZ- %" �/ APPROVAL INSPEE'fC�RS SIGNATURE DATE �. : �- � � , �� , ., �� ,,. "; �,� . � .. , � � :` , , �� , . _..,. .. . .. ,.: � ;: , . , ... � �.�. �;ity of N'ridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977