P - 44999Building
Inspections
763-572-3604
763-502-4977 FAX
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 7-1-2010
DATE ���/ �i �/ D YOUR E-MAIL ADDRESS
SITEADDRESS �t��! 'TcnniSOn �f. rJ•E�
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THIS APPLICANT IS: ❑ OWNER �"CONTRACTOR
Permit No.
Received By:
10
PROPERTY NAME: �a r�• r S �!� t�Ot> e/'
OWNER/ ADDRESS: ���j/ / j nn : se � �/" . CITY �i ��+� � STATE�I/LIP��
TENANT _ _ _ _ . '
CONTRACTOR COMPANY NAME:
CONTACT PERSON: e$rth & Home Technolo ies In
SUBMIT A COPY OF � � ear Ho� DATE
YOUR STATE STATE LICENSE # Ucense �gp
LICENSE WITH �� 0 N. Fairview Ave, CITY STATE ZIP
ADDRESS: R^seville,—i��r' � -
APPLICATION pHONE g57/633-2561 FAX
PERMIT TYPE
TYPE OF WORK:
J�SINGLE FAMILY ❑ TWO FAMILY
�NEW ❑ REPLACEMENT ,
DETAILED DESCRIPTION OF WORK in c,�w /� G
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
L'�tv/a�e� insG!"� H/�Gti
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVI�
PROVIDE HEAT LOSS CALC'S PER MANUAL J 200 ASHRAE HANDBOOK. p
Equipment Installed MFG: �[2'��O MODEL: �� e�,�iQFl� SIZEBTU ��7
MFG:
MODEL:
MFG: MODEL:
_A/C $25.00 �FIREPLACE (GAS) $15.00
_AIR TO A[R EXCHANGEER $15 FIREPLACE (WOOD) $35.00
BOILER E35.00 �FURNACE $35.00
CHIMNEY LINER $10.00 GAS DRYER $10.00
DUCT WORK $10.00 rGAS PIPING $10.00
SIZElBTU
SIZE/BTU
GAS RANGE/OVEN $10.00
NEW GAS GRILL $10.00
GAS UNIT HTR $10.00
POOL HEATER $35.00
VENTILATOR S15.00
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 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 work which requires review and approval of plans.
'/ � r
SIGNATUREOFAPPLICANT � �—� PRINTNAME KC�� n/'P%S � i e DATE /'? /�i /O
� —
APPROVAL INSPECTORS SIGNATURE
DA'
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977