P - 46483�Building
Inspections
���-s�2-3saa
763-5:02-4977 FAX
DAT6 t I` Cl •+ 1
SITE ADDRESS �,�1�
THIS APPLICANT IS:
P1aOPERTY NA
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From: 651-925-0070 Page: 6/7 Date: 11f10/2011 9:20:02 AM
MECHANICAL
RES�DENT'iAL APPLICATION
CITY OF FRIDLEY
EEFECTIVE t-1-20L1
YpUlt B-MAIL ADDRESS C i�w.,f'�n ��(i .
❑ OWNER
Permit No.:
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Cl�r:�:BACTOR COMPANYNAME: �v1(� ^ �1,�
SUBMIT A COPY dF �ONTACTPERSON: (j�.Y1S�1'1 ,_,_
Y�) tJ R STATE STpTE LICENSE #� �j�Ia (�� Q m EXP DATE • 7 �'�,� � Z
L ::^:SB W1TH ADDRESS: ICC�� •+Z i� �1� 1� IT1' STATE�ZIP ���e
h 'T.t�ATION /� � t-� —
PHONE – � • FAX � .f�7 �� �'1; rL�'J'�SO 1
PF.F? A4 TT TYPE l���LE FAMILY ❑ TW0 FAMILY
Tl'�:�'. OF WORK: I C7r�rEW
f3 TOWNHOi3SE
❑ ALTERATIONlREMODEL
AE`:' �'.'7 DESCRIPTTON OF WORK 12 � Q. � 1 �(,N S'�`(�.� �,Y��� 11 1�Y'.Vl�.r,��l`
FEE� � 33ASED ON 510.00 PER FTXTURE, EXCEPT WHERE NOTED. F17tTURES: (INDICATE TOTAL NTJA4BEg OF EACR BELOW)
PRO6 ... �: tCEAT LOS5 CAI,C'S PER MANUAL J 2p06 ASHRAE HAIV➢BOOK.
Fque;.�.;�_�,.�, :nstalled MFCr: MODEL: SIZEBTU �
B�iFG; MODEL: SIZEJBTU
MFG: MODEL: SIZEBTU
4' ' �'� FIREPLACE (GASy S I5.00 GAS RANGE/OVEN $10.00
_H ; :=.IR EXCHANGEER $lS �FiREpLACE (WOOD) $35.00 NEW GAS GRIi.i $10.00
�Fi ti35.00 EIJRNACE $35.p0 �(iAS UNTT HTR S1OA0
_(° !;Y LINER $l0.00 lGAS DRYER SIAAO _POOL HBATER 533.00
_ I, ORK S 10.00 CiAS PIPTNG $10.04 VENTILATpR SI5:00
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THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED �
-.ply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
+ e �vith the ordinanccs and codes of the City of Fridley and witih the Minnesota Construotion Codes; that I understand this is
:�ut only an applic ion for a permit and work is not to start without a permit; that the work will be in accordance with the
:n in the case of al ork '' quire e ie �nd approval of plan
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UP APPLICANT P T NAME e+ � DATE �� "(• � I I
City af Fridley
B ' ' g Inspections Department
6431 University Avenue NE, Fridley,lVlN 55432
7b3-572-3b04 FAX: 7b3-502-4977
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