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P - 42364Bui�d�z�g MECHANI�AL rnspections R�SYY3�N'x'� .A►.P�'�.,��ATIUN 763-572-3604 ���.,� ��, �,����X 76�-502-4977 FAX ����,-,,.,�, ,o �o �o xou� �n�nu, a��x£ss SITE ADDRESS l l D�'1 j,�_� "` ��� ��I G THIS APPLICANT IS: 0 OWNbR �ONTRACTO�t PRQPERTY N�- Y G � Qw�vEtt� a�Dx�sg; 6�-1 I TEI�ANT l . � � � a y, �n � i` • • ,�7����3'/r;,� �� � - - , : ..���► .T : ' - ' � �` . . � 1 1 � i � 1 ' �� � � L.vi� i ica�., t vn �OMPANY NAME: U 1 4 C�X.'T � y� SUBMTf A COPY OF cox�rACr r�.RSOrr: �ha.ln�� G Or11�s OY1 XOUxt STA'I'� STATE LICE�NIS•E �{ �% EXP DATE Y.IC�NS� WC'� .413b�SS: i]C1��[} 'm�Yifi.� � 1�1.� �� CffY.�')� Q,�_STATE�i�IP�°� a���zcnTTOx pHOrr� (� Sl- �{ �°1-�'�70 �Ax 1�51--� 3 g DS1 � P�RMIT x1'�'� ''il� S�GLE FAMIl,Y � TWO FAMII.Y ❑ TOV�TTFiOUSE TYPE OF WORI{: O N�vV �I REPLACbMENT ❑ AL'I'�,RATION/R�MOD£L nETA,IL�D D�.SC�PTION 4F �IORK FEFS ARE SA$�D ON S10.00 PER 6DCT(JRE� EJCCEPT WHER$ NQTED_ FDCT(JR.E$� (INDICA'C$ TOTAI, NlJbi$�R OF $ACfi $ELO� �'quipment Immlled MFQ: MOb�L.: STZEBTif �o-(,�o�c �a��.:J.��",Oay s�� a ��, l�ffCi� MObEL: SIZE�BN �A/C 525.00 _FIR.EPLAC� (GAS) 515.00 � _GAS RANG�'JOVEN $10-00 AIR TO AIR EXCHANQEER St5 _FIR�PLAC� (WOOri} S35.Od _AIEW GA$ GRTLL S10.00 _BOILER $35.00 �NAC� 535.00 _GAS UNTT H'TR $10,00 _C[-IIIvtAIEY LINER 510.00 _GAS bRYER 510.00 POOL 1iEwTE�t $35A0 DUCT WORK 510.00 (3A$ PIPING $10.00 VENTA.A1'OR 515.00 . , . , . ; r; . � , Numqoc 0�fixt�irOS � 510.00 ;� �510; 00 � $ . , , ' . Nu�ber'of �xtui�es C�$;��5:Oo;`:x��iS:oo = � �� � � . �,,.. :,� �: � . - ,, . - ,�<; , •:. ; , . . -. . : . . .. ,.;; .., �:.� ;; N " of f . � $ � , .00 .. . � .X . : ., ; ; ; . `' F � ,�' . ; ��.. : �' ����'. �' ....r��. ��� ��t.� ..'a.�`.:..�. .,. . , , . . . umber: ixt�u�s .2�.. .{J'_ $25.00 - $� ` ` . , :. .. , ,,�.,.. _,,.. ;.�,.,., �s � - ; r,. J.t�;�; , . - , � i�''� '�'3�;`. �';i' �'1 i'i. , +' � , : �,. ,. . , . N+.un.ber of�.,,. ;s��:oo .._ �`�.'s:o� ���-- - . �.. y� , .,.� ,. , � . Lt.`� ' �� i .,"G',Sayq., . �� .,. . .. . . ' .� r.iv': :F �r ��'! : '�hI';�1.! . .. C1fr�i�l�..�' �'i::. ,f�.� 'i:l . , ' , . i''4 1 '� ��•��� . . ' , ., '.A:'..C�[i n ��i�1�C .;� .. . �J � .. . . . . . S'�C SU�'C I '�.� $ ' t E',f7 � ,�1' . . '.iid� � c:. � ��F�...� t,. �[:, :;r.: i. . . � y„ � � ��� � '� �' . 4� � , �, , � .(l4IxIYiMLi1�I`���'�3'�.ra0� 'i�ot'�I'�'� ��' , �' "i ' . THIS IS AN nPPLiCATION FORA PERMIT-NOT VA�It] UNrIL pROCE5S�D 1 hereby apply for a buflding permit and I acknowledge chat the info�ma�ion above is complete and accurate; tha� the work will be in conformance witt� the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an applica 'on for a permit and work is not to start withaut a permit; that tl,e work will be in accordan;ce with the approved plan in the ca�e of al rk which req e review and approval of plsns. SIGNATUREOFAPPT.ICANT ' PRINTNAMS�en�n�s Do�rr nA7E ��` !'�p City of Fridley B�i�dx�g Insgections Department 6431 University Avenue I�, �'ridley, MN 55432 763-572-3604 �'AX: 763-502-497� Wd £6�£O�L4 OLOZ/U9 �al�a 4/6 �a6ed unnou�un :wa�