P - 45710Building
Inspections
763-572-3604
763-502-4977 FAX
DATE " —
SITE .�DRESS '
TFIIS aPPLTCANT IS:
PROPERTY
OR'NER/
TENAN'I'
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERNIIT TYPE
TYPE OF W ORK:
i-:
N.�fE:�
_�.DDRESS:
PHOIV�: '
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTI4 E 2-19-09
YOUR
con�.arn� rr.�,t��: Standard Heating & Air Condmornng
corrr.�cT PExsorr: Ymo
-{yin�ea�a�-Po�Pd-5�4" -04�
STATE LICENSE �t F 17_R7d-7� DATE
?.DDRESS:
PHONE
F�IILI' ❑ T�'O F.�IILl"
❑ rrE�v �PL.acEn-¢rrT
DETAILED DESCRIPTION OF WORK
FAX
❑ i'O�(NHOUSE
❑ .4LTERATION'REI�•fODEL
Perinit No.:���
Recei�-ed B�
Daie Rec'd:
�EC'D � �
ST.aI'E ZIP
FEES ARE BASED ON $10.00 PER FLXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NLTMBFdi OF EACH BELOV�
Equipment Installed MEG: MODEL: SIZFBTU
XA/C 525.00
_AIR TO A.a2 EXCHANGEER $15
_BOILER S35_00
CHIIvII�IEY LINER 510.00
�nucr woxx $io.00
MFG � MODEL: ��_
MFG: Ci✓YY MODEL: _�l�
PLACE (GAS) $15.00
PLACE (WOOD) 535.00
�[FURNACE 535.00
J`GAS DRYER $10.00
GAS PIPING $10.00
SIZFJBTU � v ;
SIZF/BTU %
GAS RANGFJOVEN Sl .00
_NEW GAS GRII.L �10.00
GAS IIIIIT HTR $I0.00
POOL HEATER 535.W
VENTILATOR 515.00
THIS IS AN APPLICATION FOR A FERMIT-NOT VALID iJNTii. PROCESSED
I hereb<< apply for a building perniit and I ackno�� ledge that the infocmation above is complete and accurate; that the «�ork ���ill be in
confotmance �rith the ordinauces and c of the Cih� of Fridley and it-ith the Minnesota Construction Codes; that I understand tlus is
not a perniit but o licati a pe iit and work is nat to start et�ith t a perniit; that Yhe wo c�-i11 be in acco ance �.vith the
approved plan the c w r which quires review and approval of p . � ���
SIGNATURE UF _ L A pR1I•I'I' N,�-fE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fndley, MN 55432
763-572-3604 FAX: 763-502-4977