P - 59367Building
Inspections
763-572-3604
763-502-4977. F
DATE _�'�
S[TE �DRESS
1FIIS ?.PPLICANT IS:
PROPERTY N_�,�:
OR'NER/ ADDRE:
TENANT'
PHONE:
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIV"E 2-19-09
� YOUR E-MAII, AD
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O O\� CON`I'R.aCTOR
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con�arrl� rr.:�n�: Standard Heating & Ai� Cond�hontnq -- —
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CONTACT PERSON:
STATE LICENSE tk � 17 1R7d_'�� DATE
ADDRESS:
PHONE
F,aA•IILI" ❑ TWO F.��III,Y
❑ NE W �EPLACEA-fENT
DETAILED DESCRIPTION OF WORK
CITY
FAX
❑ TO��NHOUSE
❑ .4LTERATION•'RE1�4UDEL
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STA'['E ZIP
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBII2 OF EACH BELOV�
Equipment Inatalled MFG: � MODEL: $i7.F1g'1'[)
MFG MODEL: � SIZFJBTU
�( �G� MODEL: SIZFJBTU
/\ A/C $25.00 FIREPLACE (GAS) $15.00 GAS RANGF/OVEN 510.00
_AIK TO AIR EXCHANGEER $15 FIREPLACE (WOOD) 535.00 NEW GAS GRILL 510.00
_BOII.ER 535.00 _FURNACE 535.00 GAS IJNIT HTR $10.00
_CFiIl�INNEY LINER 510.00 GAS DRYER $10.00 POOL HEATER 535.00
DUCT WORK $10.00 GAS PIPING $10.00 VENZTI.ATOR $15.00
'�`� THIS IS AN APPLICATION FOR A FERMIT-NOT VALID LJNTIL PROCESSED
I hereb�� apply for a building perniit and I ackno� % dge tt�at the information above is complete and accurate; that the �;-ork will be in
conformance �vith the or � ic d codes of of Fridley and �uith the Minnesota Construction Codes; that I understand this is
not a perniit but only app a n r a pe it an w rk is not to start «�ith t a perniit; that the cvo r will be in acco ance tvith the
approved plan in the ase of o �ch quires r iew and approval of p . �
SIGN.4TURE UF APPL • N::�hJE ,�.
.
City of Fridley
Building Iaspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977