P - 35469Building
Inspections
763-572-3604
763-502-497ti F
SITE ADDRESS
THIS :�PPLICANT IS:
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 2-19-09
u
PROPERTY N �,�:_
OWNER/ aDDRESS:
TENANI'
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
YOUR E-MAII, ADDRESS
CIT'Y � i'
�
COb1PANY N.�fE. v�a��..a�.. � ��.�..�..y .... ... �..,........,... ..
CONT�.CT PERSON: y �
STATE LICENSE # R 17_R7d_7� DATE
ADDRESS: CITY
PHONE
FAI4IIL1' ❑ T�'O F.AMII,1'
❑ NE�I' ,@1REPLACEI4fENT
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DETAILED DESCRIPTTON OF WORK
FAX
❑ AL
❑ TOWNHOUSE
Permit No.:
Recei�-ed Bv: ✓v��
��e��� �, ��
STATE ZIP,
FEES ARE BASED ON 510.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBFR OF EACii BELOR�
Equipmeat Installed MFG: MODEL: SIZE/BTU
MF • MODEL: V `7-� SIZFJBTU �
MFG: MODEL: SIZF/BTU
_A/C 525.00 PLACE (GAS) S 15.00 GAS RANGE/OVEN 510.00
_AIIt TO AQi EXCHANGEER $15 FIREPLACE (WOOD) 535.00 NEW GAS GRILL 510.00
BOII.ER 535.00 �FUKNACE 535.00 GAS UNTI' H1R 510.00
CFIIIvII�EY LINER 510.00 _GAS DRYER $10.00 POOL HEATER �i5.00
DUCT'WORK 510.00 _GAS PIPING $10.00 VENI'II,ATOR 515.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNITL PROCESSED
I hereb�� apply for a building pemiit and I acicno�i�ledge that the information above is complete and accurate; that the «�ork �vill be in
conforman ordinances of the Citv of Fridley and w�ith the Minnesota Construction Codes; that I understand this is
not a pe it but nl} ppliea �o for miit and work is not to start tivith t a pemiit; tl�at the wo r���11 be in acco ance tvith the
approv pl �1 w rk whic requires review attd approval of p a�s. . _ � � � �
PRINT N
City of Fridley
Building Inspections Departmeat
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
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