P - 45005Building
Inspections
763-572-3604
763-502-4977 FAX
DATE � C1� / '
3ITE ADDRESS �
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
�- � � � .... ��
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-20] 1
_ YOUR E-MAIL ADDRESS ! 1.^ � o v�, v
C7 OWNER
CI7l'
PHONE: � 4
CONTRACTOR COMPANY NAME:
SUBMIT A COPY OF CONTACT PERSON:
YOUR STATE STATE LICENSE # DATE
LICENSE WITH qDDRE55: CITY
APPLICATION �e� (�'ai+ip,rMN-§5344
PHONE _ c��_�( �. FAX
PERMIT TYPE ���GLE FAMILY � TWO FAMILY
TYPE OF WORK: � NEW �PT ACEt„ENT
DETAILED DESCRIPTION OF WORK '�i1�. L
❑ TOWNHOUSE
0 ALTERATION/REMODEL
%
Perm it No. d �
Received By:
'°�€�'�'��
A
2 t� 2Q1
�� . �
IP ��7iC �
ATE ZIP,
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALC'S PER MANUAL J 20�AE HANDBOOK. ����/ �°�
Equipment Installed MFG: �'�/ .� MODEL: ��%�=�-r--i�+�1 / SIZE/BTU �
MFG MODEL: SIZE/BTiI
MFG: MODEL: S1ZE/BTU
A/C $25.00 FIREPLACE (GAS) $15.00 GAS RANGE/OVfiN $10.00
_AIR TO A(R EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
BOILER $35.00 FURNACE $35.00 _GAS UNIT HTR $10.00
`CHIMNEY LINER $]0.00 AS DRYER $10.00 POOL HEATER $35.00
�DUCT WORK $10.00 GAS PIPING $10.00 —
— �„ , — _VENTiLATOR$15.00
�/ THIS IS�Pd�AE
I hereby apply for a building permi
conformance with the ordinances and co � of
not a permit but only an applic ' n fo a
approved plan in the case of 1 w k r
SIGNATURE OF APPLICANT
APPROVAL INSPECTORC SIl:tv irR� %�'�
TION FOR�,i�&Rivtf1PN07' VALID UNT1L PROCESSED
ge at t e m ormation a ove � �..ar�.d accurate; that the work will be in
'dley and with the Minnesota Construction Codes; that I understand this is
work is ot to start without a permit; that the work will be in accordance with the
�evi a d approval of plans.
ARINT NAME_��LG�/✓B�'" �AAII'F. �7/ /� i'��
DA
City of Fridley
uilding Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
�