P - 35264Building
Inspections
763-572-3604
763-502-49Z7 F
DATE ` � �
SITE �DRESS �
TFIIS ?.PPLICANT IS:
PROPERTY
OWNER/
TENANT
MECHANICAL
RESIDENTIAL APPLICATIQN
C'ITY OF FRIDLEY
EFFECTI�%E 2-19-09
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ADDRESS: Q 3
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Permit No.. � i
Recei�-ed Bv! �
D�i�IQ�'� � �
CONTRACTOR �or;�_:�. N.;�,�: Standard Fieating & Hir t;onamonmg
SUBMIT A COPY OF
CONTACT PERSON: ym0
YOUR STATE STATE LICENSE # F 17 R7d_7� DATE
LICENSE WITH a,DDRESS: CITY STATE ZIP
APPLICATION
PHONE FAX
PERNIIT T'YPE +�SINGLE Fr1I�IIL1' ❑ T'il'O F.M�III,I"
TYPE OF WORK: I❑ r�w ��,a.cE�•¢rrr
�r���.� �.SZ.���ra� •�n:�:�
Q TO�rNHOUSE
❑ AL,TERATION/REMODEL
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FEES ARE BASID ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBFdi OF EA.Cii BELOV1�
Equipment Instalied MFG: MODEL: SIZE/BTU
MFG: �'rl MODEL: -J ( � SIZFJBTii�:�-1-=
j� MFG: �'Z MODEL: _�� SIZFIBN �
`� A/C 525.00 PLACE (GAS) $15.00 _GAS RANGE/OVEN 510.00
AIIt TO AIIt EXCHANGEER $15 PLACE (WOOD) $35.00 NEW GAS GRILL 510.00
BOII,ER 535.00 �FURNACE $35.00 GAS IJN1T HTR 510.00
_C.�IIIVlNEY LINER 510.00 �GAS DRYER $10.00 PUOL IiEATER �i5.00
DUCT WORK $10.00 _GAS PIPING $10.00 VENTII,ATOR 515.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNITL PROCESSED
I hereby apply for a building pemiit and I ac that the infocmation above is complete and accurate; that the u-ork ivill be in
conformance �vith the ordin es and codes th . Fridley and �vith the Minnesota Construction Codes; that I understand this is
not a perniit but onl}' an plic i n a p ml and �vo k is not to start �vith t a permit; that the �vo -�i-ill be in acco ance with the
approved plan in the c e of al w 'ch re - es rev ew and approval of p s. � /
SIGNATURE OF APPLI .�,� 7 ( �
v City of Fridley
Building Inspectioas Department
6431 University Avenue NE, Fridley, MN 55432
753-572-3604 FAX: 763-502-4977