P - 45670Building
Inspections
763-572-3604
763-502-497� F
MECHANICAL
RESIDENTIA.L APPLICATION
CITY OF FRIDLEY
EFFECTI�- E 2-19-09
DAT'E V� r' y� V 1
SITE .�DRESS �
THIS APPLICANT IS: ❑ 0�1NER
PROPERTY N.�,¢
OWNi+RJ �DDRES
TENAN'I'
PHONE: i � ,
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
YOUR E-MAII, DRESS
7�� �S�
COniPANY N.^11yLL . V\QI IY41 �J � �..u., �y .., . ... ..,.,........,... �
CONTACT PERSON: Ym0
STATE LICENSE # �17 1R7d_7� DATE
?.DDRESS:
PHONE
F�IILZ' ❑ TA'O F.4I�4II.1"
❑ NE«' �EPLACEI�4ENT
DETAILED DESCRIPTION OF WORK
CITY
FAX
❑ TO�NHOUSE
❑ .aLTER:ITION%REI�iODEL
�Permit No.;�����
Recei�-ed B�-(�
Date���� . , r -� . `� � �
�TE ZIP
FEES ARE BASED ON $10.00 PER FIXTIJRE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOV�
Equipment Installed MFG: MODEL: SIZE/BTU
MFG '�yy' MODEL: ! 1 � SIZFJBTU -�
MFG: MODEL: SIZFJBTU
�1/C 525.00 b'IREPLACE (GAS) $15.00 GAS RANGE/OVENS10.00�
_AIK TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $3S.Q0 _NEW GA5 CsRII.L SI0.00
_BOIL.ER 535.00 FURNACE $35.00 GAS UNTf H'I'R $10.00
_CHInINEY LINER $10.00 GAS DRYER $10.00 POOL HEATER 535.00
_DUCT WORK $10.00 _GAS PIPING $10.00 VENTII.ATOR $15.00
I hereb�� appl_y fo t
coniormance �v� the
not a perniit t onl}'
approved pla in t�c
SIGNATURE OF APPLICANT
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID iTN'I1L PROC:ESSED
mit/�iiid I a o dge that the information above is complete and accurate; that the ��-ork ���ili be in
and cod of the� C h� of Fridley and �>-ith the Minnesota ConsYruction Codes; that I understand this is
�n for pem�it an work is not to start �vith t a perniit; that the wo - t�-ill be in acco ance tvith fl e
�rk ch require review and approval of p s.
N.�� U �r � l )
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977