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P - 35751Building Inspections 763-572-3604 763-502-4977 FAX DATE �'02 7 ' �( SITE ADDRESS ��Q 3� THIS APPLICANT IS: PROPERTY NAME: OWNER/ pDDRES TENANT CONTRACTOR SUBMIT A COPY OF YOURSTATE LICENSE WITH APPLICATION MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE ]-1-20] 1 ❑ OWNER COMPANY NAME: CONTACT PERSON: STATE LICENSE # PHONE YOUR E-MAIL ADDRESS 'S e �dC'�,` VC. �R;t, �iCONTRACTOR � / !�l n rrcS'c� � ct� l�Ri 457-539�i ,r �- � - • - - PERMIT TYPE � SINGLE FAMILY O TWO FAMtLY TYPE OF WORK: � NEW � REPGACEMENT DETAILED DESCRIPTION OF WORK FAX Permit No.: Received By:� Date Rec'd: ���� ( � TE Z[P EXPDATE y� CITY_ ���G%/ZP S7ATEL1%�!LIPS.S�3�/ ❑ TOWNHOUSE ❑ ALTERATIONiREMODEL FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL IVUMBER OF EACH BELOW) PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK. Equipment Installed MFG: MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU A/C $25.00 FIREPLACE (GAS) $I5.00 GAS RANGE/OVEN $10.00 _A1R TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 BOILER $35.00 FURNACE $35.00 GAS UNIT HTR $10.00 MNEY LINER $10.00 GAS DRYER $ I 0.00 POOL HEATER $35.00 UCT WORK $] 0.00 _GAS PIPING $10.00 �/GENTILATOR $ I 5.00 THIS [S AN APPLICATfON FOR A PERMIT-NOT VAL[D 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 per ' and r 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 req es evi and approval of plans. SIGNATURE OF APPLICANT .�'�� �i'" i�' PRINT NAME ��`1/T � ,^� I% Cy ATE_ �°�� �� APPROVAL INSPECTORS SIGNATURE ( iL'i,GL�"�"'� DATE `��� � �- � l��' City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 �� �� 763-572-3604 FAX: 763-502-4977