P - 44173Bu�lding MECHANICAL
,Inspections RESIDENTIAL APPLICATION
�63-s�2-3604 CITY OF FRIDLEY
763-502-4977 FAX EFFECTIVE 1-I-2011
DATE v /
SITE ADDR S � `
THIS APPLICANT 15:
PROPERTY NAME:
OWNER/ ADDRF
TENANT
�
❑ OWNER
YOUR E-MAIL ADDRESS
KSd�- N��
—=`�- i f � �.
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Permit No.!�-d=,ll �U
Received By�� w��_
����� �
TATE�IP,
CONTRACTOR COMPANY NAME:
SUBMIT A COPY OF CONTAC7' PERSON: �
YOUR STATE STATE LICENSE # �1?�.�,,,,,
LICENSE WITH ADDRESS: ����n AV@�Q�Ty STATE ZIP
APPLICATION �'
PHONE q���
PERMIT TYPE
TYP� OF WORK:
j�i�GLE FAMILY
/
❑ NEW
DETAILED DESCRIPTION OF WORK
❑ TWO FAMILY
PLACEt�iENT
❑ TOWNHOUSE
❑ ALT6RATION/REMODEL
FEES ARE BASED ON $10.00 PER FIXTURE, BXCEPT WHERE NOTED. FIXTLIRES: ([NDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2��,6�SHRAE HANDBOOK. ���� ��l f� ��'="' �
Equipment Installed MFG: i/1%�-L • MODEL: SIZE/BTU
MFG: MODEL:
MFG: MODEL: ______�
_A/C $25.00 FJREPLACE (GAS) $ I5.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00
_BOILER $35.00 �URNACE $35:D0
_CHIMNEY LINER $]0.00 GAS DRYER $10.00
_DUCT WORK $ ] 0.00 _ _GAS PIPING $10.00
� THIS IS AN APPLICATIOt� FOR A ERMIT-NOT VALID LJNTf
I hereby apply for a building permit and 1 acknowledge that the in or � �e s c
conformance with the ordinances and codes of the City of Fridley and with the Mi o
not a permit but only an application f^ a permit and work is not to start y�out p �-rq1
approved plan in the case of all work whic quires re�iew and approva2�of �la �
SIGNATURE OF APPLICANT
AL
�
DATE
SIZE/B'1'U
S1ZE/BTU
GE/OVEN $10.00
L $10.00
S T $10.00
$35.00
VENTILATOR 5.00
�plete and accurate; that the work wil] be in
Construction Codes; that I understand this is
that the work will be in accordance with the
�
'.�
DATE
, i .
City of Fridley ��
' ding Inspections Department
1 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977