P - 42380From: City of Fridley To: 7634346484 Page: ZI3 Date: 8/3/2010 3:00:42 PM
Building MECHANICAL Permit No.: �1;� �,'�
�nspections RESIDENTIAL APPLICATIQN Received By: '?�1`""f" ;°
763-572-3604 �jTY OF FRIDLEY ��e�+��--
763-502-4977 FAX �HN�.c-r�v� �-i-2o,o
llATE A �� g tt S t 4, 2 � 1 � YOUR �;-MA1L ADUR�SS
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TH15 APPLICANT 1S: ❑ 014'NER C�E'ONTKACTOR
PROPERTY NAM�: Gordon Peterson
OWNERJ ADllKE5S: p C17Y � , STAT L1P
TENANT 4 5-�-� � r--� � � � �1 �' �-�Te� ��� �-�-4� 2
pH�N�;: ��-57�-1 5�5
CONTRACTOR LpMPAN Y NAM�:__An � e r S O Tl R u r n Pr � e r�r i ca� T n �
SUBMIT A COPY OF CONTACT PERSON: H o wa r d o r D i
YOUR STATE STATE LICENSE tt 5 5 2 0 � 2 � g EXP llATE 12 — 2 0-10
LICENSE WITH allvx�,ss: 17535 Chisholm St . NE ��Ty Ham Lake sTar�N "LIP 5530
APPLICATInN pH�N� 763-434-6464 rAx same
PERMIT TYPE � SINGLE NAMILY ❑ Tlti'0 FAMILY ❑ T0INNHOUSE
TYPE OF WORK: ���'w �7 K�PLAC;�.M�,NT ❑ ALT�RATIONiR�M011�:L
DBTAILED DESCRIPTION OF WORK i n s t a 11 A C
}�.�,5 AIZE BA5ED OV $10.00 PER tiX7'UKN:, EXCEP7' WH�:IiE VUT�:D. F1X'1'URN:S: (1VDICA7'H: TO'fAL VUVIB�,R OF EACH BL�LOW)
PRUVID� H�A'f LOSS CALC'S PEK VIAVUA}�d Z006 ASHRAL� HAVDBUOK.
�:quipmentlnstalled MFG: Lucane M�v��,AAE4AC13L24P S�rr�sTU 2 ton
MNG: M011�.L: Sl'G�:/BTU
MNG: MOi�tiL: SI"L�/BTU
1A1� $25.00 NIR�PLACt ('GAS) $15.00 GAS ItANG�/OVk;N $10.00
AlR TO A1R �XCHANG��.R $15 �r1R�PLAC�, (1A'OQll) $35.00 N�W GAS GRILL $10.00
BO1L�,R$35.00 �FURNAC�$35.00 GASUNITHTR$10.00 "
_CHIMNEY Ll N EK $10.00 GAS llKY ER $10.00 POOL HEAT�K $35.OQ
llUC:T N'QRK $ ]0.00 �GAS PIPING $10.00 VtNT1LATOR $I5.00
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���'bar a� f�c���.°� � ��5 � � �c $2� � � � �
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T'H(S IS AN A PL 'ATION NOR A PERMIT-NOT VALID UNTIL PROC�:SSEll
1 �cby apply for ding permit and I acknawluigc that thc information abovc is complctc and accuratc; that thc work will bc in
conform i� thc ordinanccs and codcs of thc City of Fridlcy and with thc Minncsota Construction Codcs; that I undcrstand fhis is
not a permit but only an ap�lication f crmi n ork is not to start without a permit; that thc wark will bc in accordancc with thc
approvcx3 plan in thc casc of hi ires icw and approval of plans.
SIGNATUREOFAPPLIC PRWTNAM� Howard Anderson vAT� 8-4-1-0
APAKOVAL 1NSPECTOK5 SIGNATURE DATE
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City of Fridley
Building Iaspections Department
6431 University Avenue NE, Fridley, MN 55432
7b3-572-3b04 FAX: 7b3-502-4977