P - 42760From: City of Fridley To: 7637816681 Page: 2/4 Date: 5/27/2009 12:30:38 PM
BU11CIlIlg MECHANICAL Permit No.: r C�
Inspections RESIDENTIAL APPLICATI�ON Re�ei`'ea �y: �
;<�_5�2 ���4 CITY OF FRIDLEY D������
; 6_� 5U2-�977 FAX —
�,r�H�r:cTiv�: 2-� �-o�
1:����' ( � ��J �� � YOUR �;-MAIL ADDRESS
--
---%-�---'--y' ---4,,--`
� ! � ; ; f ) ll IZ ES S �' _�r ! --i �� V V�-- -------- _ ----------
: ii;� ,APPLICA,AT I�_ ❑ OWN�R (�('ONl�RACTOIZ �------
PROPER"I'Y
O��'NER
I' E :ti a �V' T
COtiTR�CTOR
SI_�E3:'�11T _-� COPY OF
YOUR ST.�TE
Lt('E\SE WITH
-�PPLICATfON
7JAM�:-f ��
����z�ss :� l
PH�N� ni,� � _
COMPA,NY NAME:_
CONTACTP�KSON;
ST,4TF LICitN/S.�� ;`
ADDRESS: l!J �,
PHONt / G,"� - .
YFiZ�II r T�'PE. ��L'�'GL� h'AMIL�' ❑ TWC) FAMIL},
TYPE OF �i ORK: C �`'��v °f�izt��A�tn�tNr
UFTAILED DESCRIPTION OF WORK ��✓� ti,.
'►'1Gr� ciTY�'.�I,
�—,�'�-
P UATE
��,___C:1 T Y _�_�
HAx7��- %�i ��'°7_
❑ T011'NHOUSt
G ALT�;ItATIONiREMOD�L
AT� /Y�'�IP �� !�.
ST A T�/�L I x-CJ. 7�1
F EES aRE BAS�:D O.\ S1p.U0 P� R h'1X7 URN;, �XC 'I''I W HN;R�; VO"CN;D. FIX'I UR�;S: (IVD1�j I�E 7'O"1'AL VUIIBER OF' EACH BELOW)
..:�iii�meri lnstalled Mh'G: ��� M011�L:�lV��QV�S�''},�'�i�-- SI'L�:%13TU
,�1 FG :
MODEL:
Mh'G: --- MOD�:L:
-.—A C ;s�.(!0 � F'IRtPLAC� (GAS) � I5.00
_AU� TO AIK E\CHA�AGEER $ I i HIR�PLACE ( WOOp) $35.00
--Li01LER 53i 0U ✓F'UKNAC� $3�.00
CHIMNtl' LWtR � 10.00 GAS llIiYER $10.00
_llLCT �1'ORK � I O.UO GAS PIPING $10.00
�unabcr o#'fixtur�;a� �>1fl,Of1 : x �:1G1.�f� � $
�'urnbrr o�� #Exnires ,�%' �13A€� x $15.€3U — $
?�umbcr ��#��xtun.� f«; �25,DE� ' x $2�.�J(3 = $
�
'�un�b��offxtures{u�3�,Q€) � x�35.€l(i---��
5[aiL Surchar�c - � r'�. �.
'' ! V
(�I1�;1_�IL:�TFEES35:�0) TQtal=� �\'�.
SIL�iBTU
SILtiBTU
_GAS RANGEiOVEN $I0.0(J
N�W GAS GK1LL $ 10.00
GAS UNIT HTR $)0,00
POOL HEAT6R $35.00
_V�;NTILATOR $I5.00
THIS 1S AN ,4PPLICATION h'OR A PtRM1T-NOT VAL1D UNTIL PROCESS�D
( hcrcb� apply for a building permit an cknowlcdgc that thc infom�ation abovc is complctc and accuratc; that thc work will bc in
�onformancc ���ith thc ordinanccs and dc,ti of thc City of Fridlcy� and with thc Minncsota Constniotion Codcs; that f undcrtirand this is
-
n�,t a permit ut onlv an application f r a permit and��vox�C,�s not tci start without a permit; that thc work will bc in accordancc with thc
anprovcd plan in thc casc of all �u "rcquiry:ti rcvic-w an�d'a roval of �lans.
�I'.;�ATl;lt� ()F' ,�1PPLIC'AN7� �,Cf
� INT NA E /�/ r' UATE �% �'�I CJ ---
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
.