P - 45298Building
Inspections
763-572-3604
763-502-4977 FAX
DATE_ i �
SITE ADDRESS �
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 7-1-2010
YOUR E-MAIL ADDRESS
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❑ OWNER '�CONTRACTOR
NAME: . � ..
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ADDRESS: 1s' CiTY
COMPANY NAME:
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Permit No.: �% t
Received By: �`°� � >
Dat��1:� i.� � �. `,� �
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CONTACT PERSON: FLOYD JOSWICK
STATE LICENSE # EXP DATE
A,DDRESS:7221 UIIlV2r51�y AVE3 N E CITY_ FY'1d1CGy STATEMN ZIP 55432
PHONE 763-572-0459 Fa.x763-572—Q164
�INGLE FAMILY O TWO FAMILY
❑ NEW '�REPLACEMENT
DETAILED DESCRIPTION OF WORK
Q TOWNHOUSE
� ALTERATION/REMODEL
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 20 �ASHRAE HANDBOOI{. )'
Equipment Installed MFG: MODEL: (J����L-u�c=f- SIZE/BTU ___���
MFG: MODEL:
MFG: MODEL:
_A/C $25.00 FIREPLACE (GAS} $15.00
AIR TO AIR EXCHANGEER $IS FIREPLACE (WOOD) $35.00
_BOILER $35.00 FURNACE $35.00
_CHIMNEY LINER $10.00 GAS DRYER $10.00
DUCT WORK $10.00 _GAS PIPING $] 0.00
SIZEBTU
SIZE/BTU
_GAS RANGElOVEN $10.00
_NEW GAS GI2ILL $10.00
GAS LJNIT HTR $10.00
POOL HEATER $35.00
VENTILATOR $IS.00
� �z .
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 comptete and accurate; that the work will be in
conformance with the ordinan s and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an appli tion 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 work whi�equ��i-eview and approval of plar�s. ,_ �
.�-�,._
SIGNATURE OF APPLICANT
AL INSPECTORS SIGNA
�
�; City of Fridley
Buitding Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
DATE �"�� r�