P - 44960Building
Inspections
763-572-3604
763-502-4977 FAX
MECHANICAL
R.ESID►ENTIAI. APPLICATION
CITY OF FRIDLEY
EFFECTIVE 7-1-2010
DATE /:" o�-a-° <<� YOUR E-MAIL ADDRESS
SITE ADDRESS I�% I /� t C,C, fl-.tic� ja-fll- 1`� �
THIS APPLICANT IS: ❑ OWNER �ONTRACTOR
PROPERTY
OWNER/
TENANT
CONTRACTOR
NAME: LJd V �4
PHONE:
COMPANY
Permit No.
Received By:
� .,., - �� �
� CITY FC2-t�4�'� STATL'�"J ZIP�S��Ji-.
SUBMTT A COPY OF CONTACT PERSON: C� ��� %� #0 6A
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH ADDRESS: a a'� � �*-� � � �"" d CITY ��2� d L,r STATE h'1�✓ ZIP SJ 4� S-
APPLICATION pHONE "Z `3- �I S 4- d-� � q FAX
PEIZMIT TYPE ��GLE FAMILY ❑ TWO FAMILY
TYPE OF WORK: � NEW (Q'REPLACEMENT
DETAILED DESCRIPTION OF WORK
❑ TOWNHOi3SE
❑ ALTERATION/REMODEL
FEES ARE BASED ON $10.00 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: �i-�t„�t.�.� M MODEL: S�M VC� l 4 SIZEBTU G4 r4 0�
MFG: e� �'t'� `a'' MODEL: c� � A� A 5�-� SIZE/BTU �. l'� �/t
�A/C $25.00
AIR TO AIR EXCHANGEER $15
_BOTLER $35.00
_CHIMNEY LINER $10.00
DUCT WORK $10.00
MFG: MODEL:
_FIREPLACE (GAS) $15.00
FIItEPLACE (WOOD) $35.00
ZCF[JRNACE $35.00
GAS DRYER $10.00
GAS PIPING $10.00
SIZE/BTU
_GAS RANGE/OVEN $10.00
NEW GAS GRILL $10.00
_GAS LJNIT HTR $10.00
POOL HEATER $35.00
—VENTILATOR $15.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID iJNTIL PROCESSED
I hereby apply for a buiiding 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 requires review and approval of plans.
SIGNATURE OF APPLICANT
APPROVAL INSPECTORS SIGNATURE
NAME � � �! �, � �r ,p p DATE / I ' 3- � -� � �
���
City of Fridley
Building Inspec�ions Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977