P - 45002Building
Inspections
763-572-3604
763-502-45�77 �AX
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 7-1-ZO10
SITE ADDRESS ( �� I �� :.J��4"16L� �
THIS APPLICANT I3: � OWNER
PROPERTY N�:
OWNER/ .ADDRESS:
TErrarrr ........� � r -� _
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERNIIT TYPE
TYPE OF WORK:
COMPANY NAME:
CONTACT PERSON:
.
STATE LIC NSE �#—'
ADDRESS�: :J �
PHONE /l( S ('�
❑ rrEw
FAMILY
DETAILED DESCRIPTION OF WORK
YOLTR E-MAIL ADDRESS
- S�i�-x--
)� /�
Ce v
3 3d �� FAX
CI TWO PAMILY
CITY
EXP DATE
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
Pernut No.
Received B�
Da�4-R��'�
�
.TEI " `' ZIP�
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVt��
PROVIDE HEAT LOSS CALC'5 PER MANUA 2006� HRAE HANDBOOK. N^ /(
Equipment Installed MFG: �!� MODEL: � f=, �i SiZE/BTU �J
A/C 525.00 -
AIR TO AIR EXCHANGEER $15
_BOILER �35.00
CHIMNEY LINER $10.00
DUCT WORK �10.00
MFG: MODEL:
MFG: MODEL:
_FIREPLACE (GAS) $15.00
�IREPLACE (WOOD) �35.00
FURNACE $35.00
_GAS DRYER 510.00
SIZE/BTU
SIZEBTU
GAS RANGE/OVEN $10.00
NEW GAS GRILL 510.00 �
_GAS LR�iIT HTR $10.00 -
�POOL HEATER $35.00
__VENTILATOR 515.00
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 complete and accurate; that the work will be in
conformance with the ardinances and cod s of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application fo permit work is not to start without a permit; that the or will be in accor anc with the
approved plan in the case of all wor ich re s review and approval of pl � �
SIGNATURE OF APPLICANT PRINT NAME ATE /
APPROVAL INSPECTORS SIG DA
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432