P - 44211Building
Inspections
763-572-3604
763-502-4977 FAX
DATE rI -` � � - i v
SITE AbDRESS
THIS APPLICANT IS:
PROPERTY N
OWNER/ A
TENANT
CONTRACTOR
SUBMIT A COPY OP
YOUR STATE
LICENSE WITH
A.PPLICATION
PERMIT TYPE
TYPE OF WORK:
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRII)LEY
EFFECTNE 7-1-2010
YOUR E-MAIL ADDRESS
❑ OWNER �ONTRACTOR
Permit No.: `; :� �' � L � '
Received B
�.-�:
r �
CITY STATE ZIP.
COMPANY NAME: YC I v a�- C� Fo. S�`� L � L��I
CONTACT PERSON: C� I1 r N �.�yp Yp
STATE LICENSE #
EXP DATE
ADDRESS: f; d-'� 0 j"� 0...�+ S E N L CITY I�� � a 1• i STATE �� ZIP ���� �--
PHONE � 6� "t g' cF- d t�`� FAX �
['�SINGLE FAMILY ❑ TWO FAMILY
❑ NEW �'REPLACEMENT
❑ TOWNHOUSE
❑ AL,TERATION/REMODEL
DETAILED DESCRIPTION OF WORK Zt�s�:�� 2, `,,pl b. �`�•-o�.�►.1-: �Q t+� Co r�d � F� �.�...
�
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXT[JRES: (INDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK.
Equipment Installed MFG: 2 v v� MODEL: vAP rl - aa�{ ��-L. SIZEBTU a r� �
MFG:
MODEL:
MFG: MODEL:
, A/C $25.00 _FIREPLACE (GAS) $15.00
_AIIL TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00
BOILER $35.00 FURNACE $35.00
_CHIMNEY LINER $10.00 _GAS DRYER $10.00
_DUCT WORK $10.00 _GAS PIPMG $10.00
siz�sru
SIZE/BTU
GAS RANGE/OVEN $10.00
NEW GAS GRILL $10.00
GAS UNIT HTR $10.00
POOL HEATER $35.00
VENTILATOR $15.00
THIS IS AN A.PPLICATION 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 all wark which requires review and approval of plans.
SIGNATURE OF APPLICANT
SIGNATURE
�r<s �` � DATE �I�3o�;V
DATE --. � L% �
�.i�' Of �1'1C�18y
/ Buiiding Inspeciions Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977.