P - 37178Building
Inspections
763-572-3604
763-502-4977 F
MECHANICAL
RESIDENTIA,L APPLICATION
CITY OF FRIDLEY
EFFECTT�-E 2-19-09
DATE "( 1,
SIT'E ADDRESS
THIS .�PPLICANT IS: ❑
PROPERTY N �:
OWNER/ aDDRESS:,
TENANI' -
PHONE:
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
YO E-MAII, ADDRESS
i�[ CMd �
ConiP.=1I�TI'N.�fE: .�...,��..�.�.. � �.......�y..,.... _...._..._...--.-
CONT.aCT PERSON: ym0
STATE LICENSE # F 17 ,R7d_7� DATE
P.DDRESS:
PHONE
F�1I�IILZ" ❑ TWO F.AI�1Q.1'
❑ NE�L' �REPLACEI�•1ENT
J \
DETAILED DESCRIPTION OF WORK
CITI'
FAX
Q TO�VNHOUSE
❑ ALTER.�TION%REMODEL
Pernut No.�U � �
Recei� ed B}-
Date ���d}� � 0 1
3�
ST�TE ZIP
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHEI2E NOTED. FIXTURES: (INDICATE TOTAL NUMBII2 OF EACH BELOVh
Equ�ment Installed MFG: MODEL: SIZElBTCT
MFG: 2".��^' l MODBL: �� i�- SIZEJBTU )
MFG: MODEL: SIZEBTU
A/C 525.00 FIREPLACE (GAS) $15.00 GAS RANGElOVEN 510.00
�AIIZ TO AII2 EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRTLL $10.00
BOII.ER 535.00 ,�FURNACE 535.00 GAS IINIT HTIt $10.00
CI�iNEY LINER $10.00 GAS DRXER $10_00 POOL HEATER �i5.00
_DUCT WORK 510.00 GAS PIPING $10.00 VENI7I.ATOR 515.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID IINTIL PROCES5ED
I hereb<< appl_y� for a building permit and I ackno�vledge that the infonnation above is complete and accurate; that the ti��ork ���ill be in
conformance �r°ith dinaiices and cod e Citv of Fridley and �a-ith the Minnesota Construction Codes; that I understand this is
not a perniit but y li on for rmit nd work is not to start «•ith t a perniit; that the �vo - t�=ill be in acco ance with the
approved plan � the c a 1 ork req es review and approval of p s.
SIGNAT[TRE OF _ PLI � �.1"[ N,�� � I� � I
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
010