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P - 41407Building MECHANICAL Inspections RESIDENTIAL APPLICATION �63-s�2-3604 CITY OF FRIDLEY 763-502-4977 FAX EFFECTTVE,-�-ZO>> DATE�1 ` ( `� -- SITE ADDRESS �� THIS APPLICANT [S: PROPERTY OWNER/ TENANT �� �� ❑ OWNER ADDRE/SS:�;Z PHONL� �� ,- YOUR E-MAIL ADDRESS �.rZ� i �} C ��LC �CONTRACTOR G ✓ i {n K:'ti �, C� � �- l� � / / r-- y��i!^+ "" �i(!',--� _`_J CONTRACTOR COMPANY NAME:� , � SUBMIT A COPY OF CONTACT PERSON: )� ► r � YOUR STATE STATE LICENSE # LICENSE WITH ADDRESS:� % � •{� I � � � APPLICATION PH� -- PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY TYPE OF WORK: � NEw �EpLACEMENT _ � DE•TAILED DESCRIPTION OF WORK .,� ti L 1,�.. EXP =� IL FAX Permit No.: ' "' L� Received By: �� ������� ".--�-� _.�_. � 7 rL�� i�.-) � � _ 1�/C. � � '�C..L f/ �. STA -n,�' � � I-1�� �� �ITY -�'iZj {�, \ STAT�ZI�� ❑ TOWNHOUSE ❑ ALTERATION/REMODEL FEES ARE BASED ON $]0.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) PROVIDE HEAT LOSS CALC'S PER MANU L J 2006 ASHRAE ANDBOOK. ��} Equipment Installed MFG �,�:�-�� � MODEL��� - p73 (G SfZE/BTU �" �� .� MFG:LZ,_/�/� l'�iK �+�^�"�r,�.CiL MODELJS�j'^,Q7Q ✓'�S� /E BTU C� Q dQ A/C $25.00 AIR TO AIR EXCHANGEER $15 BOILER $35.00 CHIMNEY LINER $10.00 DUCT WORK $10.00 MFG: MODEL: FIREPLACE (GAS) $15.00 FIREPLACE {WOOD) $35.00 FURNACE $35.00 GAS DRYER $10.00 GAS PIPING $10.00 SIZE/B7'U GAS RANGE/OVEN $10.00 NEW GAS GRILL $10.00 GAS UNIT HTR $10.00 POOL HEATER $35.00 VENTILATOR $15.00 TH1S 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 ap�lication 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 o�f � work whic r uires review and approval of�p ans. t � SIGNATURE OF APPLICANT - ` �' ,C1yti�^�y'—PKINT NAME' ��C' Z ������'/t-� DATE �`�/ l ` /� ,� APPROVAL INSPECTORS SIGNA'1` RE DAT City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977