P - 45817Building
Inspections
763-572-3604
763-502-4977
DATE �Q
SI1'E .�DRESS _
T'HIS APPLIC.�NT IS:
PROPERTY
OWNER/
TENANT
MECHANICAL
RESIDENTIAL APPLICATIDN
� � CITYrOF FRIDLEY
�
N.�fE:
aDDRESS:
PHONE:
YOUR
.
i
Permit No.�«� �
Receit-ed By:
.�:,�.�: - i� i i
CONTRACTOR �.on:�, �> N.;�¢ Standard Heating & Atr t;oncimonmg
SUBMIT A COPY OF
CONT,aCT PERSON: ym0
YOUR STATE STATE LICENSE # F 17 ,Rid_7� DATE
LICENSE V✓ITH �DRESS: CITY ST,�TE ZIP
APPLICATION
PHONE FAX
PERMIT TYPE
TYPE OF WORK: I� T����
F,aI�IILl" ❑ TA'O F,AI�IILI' ❑ TOR-NHOUSE
�N.EPLACEI�fENT ❑ AI�ERATION.'REMODEL
DETAILED DESCRIPTION OF WORK "1� I�LQ
!�
FEES ARE BASED ON $10.00 PER FIXTIJRE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBII2 OF EACH BELOVI�
Equipment Installed MFG: MODEL: SIZFBTU
MFG: � MODEL: Y- `� SIZFJBTU�O�_ v
� MFG: "' � MODEL: � SIZE/BTU — ` �
A/C $25.00 FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00
AIK TO AIK EXCHANGEER S15 FIREPLACE (WOOD) $35.00 NEW GAS GRII.L 510.00
_BOII,ER 535.00 �FURNACE $35.00 GAS UI�1IT HTR $10.00
CHInINEY LINER $10.00 _GAS DRYER $10.00 POOL HEATER 5i5.00
DUCT WORK $10.00 GAS PIPING $10.00 VENIII.ATOR 515.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID i.JN11L PROCESSED
I hereby appl_y° for a building pernlit cl.�no« ledge tliat the information above is complete and accurate; that the ���ork �vill be in
conformance �•� rd' ice d es the Cit�i of Fridley and ��-ith the Minnesota C`onstruction Codes: that I understand this is
not a pern1� ut o pp ca io or a pe it and work is uot to start �vith t a perniit; that the wo t��ill be in acco ance �vi the
approv lan in o 11 wo which ie uires review and approval of p a�s. , � � � ��
�.�.�tfi���--�!���►�C��i� � �l�i��'����-f�,����1 ��
City of Fridley
Building Inspectioas Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977