P - 45818Building
Inspections
763-572-3604
763-502-4977 F
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTI�- E 2-19-09
DATE � I /
SIT'E :�DRESS �
THIS �PPLICANT IS: ❑ O�d'NER
PROPERTY N_�,¢:
OWNER/ _aDDRESS:
TENANT
PHONE: n� _Z
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORi{:
YOUR E-MAII, ADDRESS
crri'
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Permit No
Recei�-ed
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COniP.4NI' N.�1I��. ..�icn �va� � ��caau �y a+� ..�� ................. ..
CONTACT PERSON: ym0
STATE LICENSE # � � 7_R7d_7� DATE
:aDDRESS: CITI" ST�1TE ZIP
PHONE
F�IILI" ❑ T�i'O F.=1I�fII,Y
� NE�i' �PLACEI�-fENT
� �
DETAILED DESCRIPTION UF WORK
FAX
❑ TO WNHOUSE
❑ ALTER;�TION.'REA.iODEL
FEES ARE BASED ON $10.00 PER FIXTLTRE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL N[JMBII2 OF EACH BELOVI�
Equipment Installcd MFG: MODEL: SIZE/BTU
1viF � MODEL: � SI7FJBTU J/ ' y �
MFG: MODEL: SIZF/BTU
�A/C 525.00 _FIREPLACE (GAS) $15.00 GAS RANGE/OVEN 510.00
AIR TO AII2 EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL 510.00
_BOII..ER 535.00 FURNACE $35.00 GAS IJNIT HTR $10.00
_CHIMNEY LINER $10.00 _GAS ARYER $10.00 P(70L HEATER 535.00
_DUCT WORK $10.00 __ GAS PIPING $10.00 VENTII.ATOR 515.00
���� �+ �
THIS IS AN APPLICA
I hereb�� apply for a building pemiit arid I ac t�
conformance �vith the ordinances and codes the Ci
not a perniit but only an a cat n r pe it nd
approved plan in the c of all wv ch qu es r
SIGNaT[JRE OF
)N FOR A PERMIT-NOT VALID LJNITI, PROCESSED
that the inforniation above is complete and accurate; that the ���ork �vili be in
f Fridley and ��-ith the Minnesota Construction Codes: that I understand this is
k is not to start «°ith t a perniit; tbat the wo r ttrill be in acco ance � th the
iew and approval of p . •'
����� V �,
\„J City of Fridley
Building Inspectioas Department
6431 Universiiy Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977