P - 46263Building MECHANICAL
Inspectians RESIDENTIAL APPLICATION
763-572-3604 CITY OF FRIDLEY
763-502-4977 FAX EFFECTIVE 1-1-2011
DATE � � i �
SITE ADDRESS �
THIS APPLICANT IS:
PROPERTY
OWNER!
TENANT
YOUR E-MAIL ADDRESS
O OWNER �CONTRACTOR
PHONE:�`n�l— �c'��'4U6`
CONTRACTOR CQMPANY NAME: F���Cv T� l�
SUBMIT A COPY OF CONTACT PERSON: _
YOUR STATE STATE LICENSE #
LICENSE WITH ppDRESS: � C�
APPLICATION pHONE �I—'
PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY
TYPE OF WORK: � �EW �REPLACEMENT
EXP DATE
Permit No.
Received By:
D��+�'d.�,
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❑ TOWNHOUSE
O ALTERATION/REMODEL
STATE�ZIP�
AT�IR� �QZ
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FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALC'S PER MANU J 2006 SH� DBQOK. ,�,�� ���
Equipment Installed MFG: MODEL: � � � �.S�T� �
LA/C $25.0�
AIR TO AIR EXCHANGEER $15
BOILER $35.00
CHIMNEY LINER $10.00
DUCT WORK $10.00
MFG:
MODEL:
MFG: MODEL:
FIREPLACE (GAS) $15,00
FIREPLACE (W OOD) $35.00
FURNACE $35.00
GAS DRYER $10.00
^GAS PIPING $10.00
SIZEBTU
SIZElBTU
GAS RANGE/OVEN $10.00
�NEW GAS GRILL $10.00
_GAS UNIT HTR $10.00
POOL HEATER 535.00
VEI3TILATQR $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
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 al � rk which re xires review and approval of plans.
SIGNATURE OF APPLICANT . , PRINT NAME_� �� DATE llJ S'�
SIGNATURE
DATE
D City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
?63-572-3604 FAX: 763-502-4977
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