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763-572-3604
763-502-4977 FA�
DATE ( e��
5IT@ ADARESS
THIS APPLICANT IS:
t�WNE�tI
TENANT
From: 7635720164 Page: 1/2 Date: 1014/2011 9:01:15 AM
MECHANICAL
I�ESIDENTIAL APPLICATION
C3 OWN�,It
CONTAAC7'OR f COMPANY
�ITY (�F FRIDLEY
EPPECTIVE 1-1-2D10
1'OUR E-MAIL ADDRESS
• CiTY
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���� No.: �-� �c�?ay .
Received By: ��
X7ate �t.ec'd:
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SUBMIT A GO�'Y pF CONTACT PERSON: k'LOXD JOSWiGK
Y(7UR STA'CE STAT� L[C�NSE # EXP DATE
LICENSEWI'Ii� ppp�55:7��1 Uri].VC�1'�].�'V' AV�. 1'i.E ClTY �'r�tii�+Y STATEMN ZIP 55432
APiyL1CATION P�QN� � 6 3- 5 7 2- U 4 5 9 FA3t
PERMIT '�Y�'E
TYP� C)�' W4RK:
�STNG�:E FAMJL X � TWfl FAMILY
❑ NEW a REpLACEMENT
DETAIF�Eb UES�RIPTIC3N b�' WORK
❑ TOWNHOUS£
,TERATIONIREMOBEL
FEES ARE BASED ON S�O.dO PER FIXTURE, EXCEP7' Wt�ERE NO'C�D. FTXT1J�t�S: (INA�CA,'�'� TOT�,�. NUI��ER O�' EAGH BELOW)
PROYIDE HEAT LOSS CALC'S PER MANUAL J 20Q6 AStIliAE FIAND�OOK.
Eqssipmrnt Inssalkd MFG� M�DEL: SIZE/BTU
MFCi:
Mt7DEL:
S12Ef8TU
MFG: Mf3DEL: SIZE/BTU
_g1C �'25.00 _FIREPLACE (GAS) SI5,00 GAS RANGE/OVEN S1fl.OQ
AIIt TO AIR EXCl�IANQEER S!5 FIREPLACE (WOODj 535.00 NEW GAS GRILL 510:00
^HdaL,ER S�SAd �FURNACE 535.00 GAS UtVIT HTii S t0.00
CH11�QN�Y 4R�F�ii S14.00 GAS D�,XHTt $10.00 PO(}L }��ATER $35.00
�DUCi WORK 514.00 GAS P(PiNG 510.00. J.._. _. __ __. ..____._. VENT(LATOR SI5,00
TFIIS 1S AN .4APLICqT'!UN �Uii A Y�EiM[T-)VfjT VALIp UNTIL FRUC�55�x}
I hereby apply far a br:ilding perrnit and I acknowledge thac che infnrmation abovc is carrxpiete and accu�ate; that t�e work wil! be in
conformancc witih thc ordinanets and codes of tht City ofFridley and with the Ivlinnesota Construct�pn Codes; that I understand this is
not e permit but oflly az� �ppli ation for a parmxt and work is pot to staz�t withqut a perrnit; that t�e wark wi1l bc in etccordancc with the
approved plan iu� the case of a3 work wh' req ' s review and approval oF plans.
SdGNATl1RE OF APPLICANT F'RZTdT NR.A�� � DATE L r'
APPTLOVAL 1N5PECTO�tS SIGNAT E n.aT�
City Q� �'�ridley
�uiIding I�spections Dep�rtment
6431 Univ�rsity Avenue NE, Fridley, MN 5SA32
763-572-3604 F.4�: 7�3-SQ2-4977