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Building
Inspections
763-572-3604
763-502-4977 FAX
UAT� ` 7�1� i�l I (
S1T� AllUK�,5S
TH15 APPLiCA/dT 15:
PROPERTY
OWNER/
TENANT
CONTRACTOR
ot Fridley i o: y�z��� a�y� Nage: 1i5 uate: 5�5r�uva �:�-i :�� rm
MECHANICAL permit rro.. � c� u�t� y
R.ESIDEI�ITIAL APPLICATIC}N Received By:�
CITY OF FRIDLEY pa����d��� �' � ��
�rH�cTiv� 2-t9-n4 _
YnUR E-MA1L ADUk�;SS
❑ OWN�R
ADllR�5S: C1TY
PHON�:
CQMPANY NAM
�i1''� �..
TAT� 'LlP
SUBMIT A COPY OF CANTACT P�ItSON:
YOUR �TATE STAT� L1C�NS� # � �'�'C
LICENSE WITH AllDk�SS: �� �� ��1� CITY STAT� 'LIP
APPLICATIOIV pHON� K X
PERMtT TYPE
TYPE OF WORK:
J�5WGL� KAMILY � TWn NAMILY
❑ NtiW �R�PLAC�M�NT
DETAILED DBSCRIPTION OF WORK
C] T(7WNHOUSk
❑ ALT�RATION/R�MOU�.L
FEL�� AItL� BA$LD OV 510.80 PL�It F1X'fUltL+, LXCL�P7' WHL�RL� VOT�D. F7X'fUtZL$:�L�dICA'f Tp7'AL VU�IBL�K OF L+ACH B L�
Equi�nt Inxtalled MFC,: L�no�. _ MOD�L: ��,�pB --d�J'�j S!'L�/t3TU
_,vc S2s.00
AIR Tn AlR �XCHANCiE�R $15
t3QiL�lt $35.tH1
CHIMN�Y LIN�It$10.00
�llUCT WnRK � 10.00
MNCi:
MOU�L:
MHCi: MnDtiL:
KIR�PLACti (GAS) $ I5.00
I+IREPLAC� (Wf�U) $35.00
�NU RNAC� �35.00
_,GAS DRY �K $10,00
GAS PtPING $10.00
SI'LE/B'fu
Sl'LL'/l3TU
CAS 1tANCi�/OV�N $10.00
N�W GA5 C,RiLL $10.40
CiAS UNIT HTR $10.00
PnnL H�AT�,R �35.00
V�NTILATOIL $ I3.00
THlS !S AN APPLIC:AT1bN HQR A F�RM1T-NOT VALIU UNT1L PRQC�SStiU
I hcrcby apply for a building permit and [ acknowlcdgc that thc information abovc is complctc and accuratc; that thc wark will bc in
conforrnancc with thc ordinanccx and codas of thc City of Fridloy and with thc Minncsata Construction Codc,��; that I undcrstand this L�
nat a permit but only an applicat' n for a permit and work is noi to rttart without a permit; that thc work will bc in accordancc with thc
appravcd plan in thc casc i or whic rcquires rcvicw and approval of plans.
SICNATUR�; QF APPLICANT PR1NT NAM ' UATk� `^'
City af Fridley
Building Insp�tions Dep�rtment
6431 University Avenue NE, Fridley, MN 55432
7b3-572-3b04 FAX:7b3-502-4477