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Building 1V.[ECHANICAL Permit No.:
Inspections RESIDE�TIAL APPLICAT�ON R���y� B'
763-572-3604 pafE;`R'� d:
�s3-so2-497'7 FAX CITY OF FRIDLEX
EFFF,C7TVE 2-] 9•09
pA•p� 11/17/10 YOUR E-MAIL ADpRPSS dave�davesheadngandair.com
SiTE ADDftESS �A00 Q�aciar Lene
THIS APPLICANT IS: ❑ OWNER aCONTRACTOR
PROPERTY Np�. Joyce Kourouma
OWNER/ ADDRGSS: 1400 GIeCl91' Lene CITY FRIDLEY _ 5•rnTe MN z1r �as2
TENANT 763-886-9598
PFIONF:
CONTRACTOR CpMPANY NAMB: DAVE'3 HEATINO, AIR 8 EIECTRIC
SUBM]T A COPY OF CONTACT PERSOTI: AMY MADVIG
YOUR STATE STATP,I.ICENSB � �XI' DATL�
LIGENSB WI'!'H ADDRESS: 1801 37TH A1/E NE C�Ty COWMBIA hIEIGM'I'S S�p��� MN zTp 55421
APPI..TCATfON PH�NE 783-781-6901 ppX 783-T89-B805
PERMIT TYPE �NOI.E FAMILY 13'I'WO FAMILY D TOWNHQUSE
TYPE OF WORK: Q�'W ��P�CEMENT Q ALTBRATION/REMODE4
DBTAILED DESCRIPTtON O� W�RK REPLACE DUCTwaRK IN eASEME►�T
F�FS AR& BASED ON SiQQO P�R FIXTURR, FXCF.AT WH�RC NOTRD. FIXTURES: (1NqICATE TOTAL NlJiNB1�R OF F.ACFI BEIAW)
Equipment fasWlleJ TAFO: MUPEI.: SIZ'+U67'U
MFC3: MODEL: SIZE/RTU
MRG: MODE[.� StZEJDTU
!C T25.00 ,�RIREPLACR (CiAS) $I5 00 GAS RANOFJOVEN SI0.00
IR TO AIR EXCHANGG�R SI5 lREPLACB (WOOD) 535.00 NEW GAS ORILL 510.00
�BOlL6R S3S.00 R]VACE 535.00 ,,,�CAS IMIT H'IR Sif100
CHIMNBY I..IiVER S IQ.00 AS DRY�R S10.00 POQL NEATER 535.00
DUCT WORK SI O.W QAS PIPING SI0.00 lVENTI(.ATOR SiS.00
Number oP�xtures cr a{0.00? x�10.04 =$ ����
Numbcr of fixture� (c,� $15.00 � x Sl 5.00 ° S�
Number af tiyttures (a3 $2S:00 ,,,� x $25.00 = �____,,,,,,_T �
Nurc�bar of �xturea (a� S35.A0 ____ x 535.00 �$�
State Surcharga = �,___,_,,,,,,,�Q.
INI UM I�EE �3S.:S0 Total =
Tfi1S IS AN APPLlCAT10N FOR A PERMIT-NOT VAUp UNflL PRpCE.RSBD
I hereby apply for a building pertnit and i acknowledge tfiat the informution above is completo and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridtey and with the Minnesota Construction Codes; that f undcrstand this is
not a permit but only an lication for a permit And work is not w start without a permit; that the work will ba in accordsnce with the
approved plan in the cas of I work which re uires r vicw and approval of p s.
SIGNATl1Rk G1F APPLICA + PRIIVT NAME ATg��..LS.�—
PLEASE NOTE: S.EAARATE PB ARE RE Ut D FOR BUILDINC ELEG'I`RfCAL AND CHA'NICAT. VJO1tK
�.:�_ ..r �_sa�....
a.a�J va a� s sw•vJ
Building Inspections Department
643! University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 7b3-502-4977
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