P - 48425Building
Inspections
763-572-3604
763-502-497,7 F
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
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THIS �PPLIC.4NT IS: ❑
PROPERTY N..�,¢:
OWNER/ aDDRESS:
TENANT -
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
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Permit No�6 2 �a � �
Recei�-ed Bv. �' �/ r
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Standard Heatin & A�� Loncimornng �/ -
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CONTACT PERSON: Ym0
STATE LICENSE # F 17 R7d_7� DATE
ADDRESS:
PHONE
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❑ rrEw �rL�cEn-¢tsr
DETAILED DESCRIPTTON OF WORK
CITY
FAX
❑ TO�\NHOUSE
❑ ,9i,.TERA'CION!REhfUDEL
1'E ZIP
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBII2 OF EACH BELOV�
Fquipment Inatailed MFG: MODEL: SIZEIBN
MFG �i✓Y1'� MODEL: c.�,� SIZFJB `J ) / �
MFG: MODEL: SIZEBTU
_A/C 525.00 FIREPLACE (GAS) $15.00 GAS RANGE/OVEN 510.00
AIIt TO AIIt EXCHANGEER $15 FIREPLACE (WOOD) $35.00 _NEW GAS GRILL 510.00
_BOII,ER 535.00 �FIIRNACE $35.00 GAS LJNTf HTR 510.00
CF�IIdEY LINER S L0.00 GAS DRYER $10.00 POOL HEATER 535.00
DUCT WORK $10.00 _GAS PIPING $10.00 VENTtLATOR $15.00
THIS IS AN PLF FOR A FERMIT-NOT VALID UNTII. PROCESSED
I hereby apply for a building pemiit and I ackno�� ledge that the information above is complete and accurate; that the ��-ork cvill be in
conformance �y°ifli the ordinances and codes of ity of Fridley and �a-ith the Minnesota Construction Codes; that I understand this is
not a pemiit but only an n or a it an work is not to start «•ith t a perniit; tl�at the �r�o r t3�ill be in acco ance �vith the
approved plan in the of a o �ch quires eview and approval of p .
SIGNAT[.R2E UF APP IC • N�,� �
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977