P - 45823Building
Inspections
763-572-3604
763-502-4977
DATE�
SITE :�DDRESS _
TFIIS aPPLICANT IS
PROPERTY
OWNER/
TENAN'T
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
AX% EFF'ECTI4E 2-19-09
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N.�I�fE: \
ADDRESS:
PHONE:
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Permit No.��
Recei�-ed Bv:
CONTRACTOR �on�_�. N.,,�¢. Standard Heating & Air t;ondmornng �+
SUBMIT A COPY OF
corrr.acr P�xsorr: ymo
YOUR STATE STATE LICENSE # F17 �R7d_7� DATE
LICENSE WITH �DRESS: CITY STi1TE ZIP
APPLICATION
PHONE FAX
PERMIT TYPE I/1SINGLE F,�I�fILI' ❑ TR'O F_AI�qI,l'
TYPE OF WORK: ' � ��Z �PLACEA-fENT
DETAILED DESCRIPTION OF WORK
❑ TO�iNHOUSE
❑ .aLTERATION�'REMODEL
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBFdi OF EACH BELOWj
Equipmeat Installed MFG: � MODEL: SIZF/BTU
MFG: C�� MODEL: __-�_`�' SIZFJBTU_<�y�'=� C
�( � MFG: MODEL: SiZFJBTU
=A/C 525.00 FIREPLACE (GAS) $15.00 GAS RANGE/OVEN a10.00
ATR TO AIIt EXCHANGEER S15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL 510.00
_BOII.ER 535.00 _FURNACE $35.00 GAS iJNIT HTR $10.00
_CHInINEY LINER $10.00 GAS DRYER $10.00 POOL FIEATER 535.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTII.ATOR 515.00
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I hereb<< apply for a building
not a
of all
SIGNA
T'HIS IS AN APPLICATION FOR A PERMIT-NOT VALID [INTIL PROCESSED
nit acicno�� ledge that the infonnation above is complete and accurate; that the ���ork ���ill be in
d e f the Cih� of Fridley and �uith the Miunesota Construction Codes; that I understand this is
� or a e iit and work is not to start «�ith t a pemiit; that the wo ti-il1 be in acco ance �vith the
rk wluch equires review and approval of p a�s. , _ � � � , /
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City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
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