P - 36732From: City of Fridley To: 7633237595 Page: 4/5 Date: 3/4/2010 3:29:26 PM
Building MECHANICAL Permit No.:�
Inspections RESIDENTIAL APPLICATION Receivecl By:�
763-572-3604 e��(� �' �
763-502-4977 FAX CITY OF FRIDLEY
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THIS APPLIC;ANT IS
PROPERTY
OWNER/
TENANT
❑ OWN�R ��
NAME: ��, �
AUU R�SS:
PHONt: lY. IZ� �12R�
YOUR E-MAIL AUURESS
CTOR
CITY
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CONTRACTOR L(�MPANY NAMt:y���`�`�� L�C, ��1.�
SUBMIT A COPY OF LnNTACT PEILSON: �(�� ���r-�p �u
YOUR STATE STATE LICENS� it ^'-��' EXP DATti ---'—�
L[CENSE WITH AUll1tESS: s p�IQ CITY STATE�'L1P_��i�✓
APALICATION
PHQ[�!� � r•,ax
PERMIT TYPE
TYPE OF WORK: �� N�w
NAMILY ❑ TWO NAMILY
�_tiPLACtMENT
DETAILED DBSCRIPT[ON OF WORK
❑ TOWNHOUSE
❑ ALT�ItATIONiREMOU�L
F�N:S Alt� BASN,D UV 510.00 P�R FIX"I'URE, EXC�P"1' WH�R�. VO'f�:D. F1X"1'UIi�:S: (1VDICA'I�N.'f0'fAL VU�1BN:12 ON N:ACH BELONh
PROVID� HEA'I' LUSS CALC'S PER �IAVU J 2006 ASHIi4N, HAV DBOUK. +�� G,� /��
�quipment ln�talled MFG: �`�'fi1A( MOUEL: �li`) l'f'l�,u s(� Sl'LtilBTU �� (/cJ�/
MNG:O���k�u.� MQDtL: � G!3't�� S!'LFJBTU � �TVnS
�AlC $25.00
Alli TO A IK EXCHA NG EEK $ I 5
BOl LEK $35.00
CHIMNtiY L1NtR$10.00
UUCT WORK$10.00
MFG: MODEL:
NIRtPLAC� (GAS) $ I5.00
HIREPLACE (Vb'OOU) $35.00
�FURNACE $35.00
_GAS DIiYtR$10.00
GAS P1PWG $10.00
Sl'LI:./BTU
GAS IL4NGF.lOV�N $10.00
NEW GAS GR1LL $l0.00
GAS UNIT HTR$l0.00
POOL HtATEK $35.00
VEN TI LATOR $ I 5.00
THIS IS AN APPLICATION FORA PERMIT-NOT VALIll UNTIL PILOCESSEll
I hcrcby apply for a building permit and L acknowtcdgc that thc information abovc is complctc and accuratc; that thc work will bc in
conformancc with thc ordinanccs and codcs of thc City of Fridlcy and with thc Minncsota Construction Codc��; that 1 undcrstand tfiis i.c
not a permit but only an application f a permit and work is not to start without a permit; that thc work will bc in accordancc with thc
approvrd plan in thc casc of all h_h rc uires rcvicw and approval of plans.
SIGNATURE OF APPLICANT PIiINT NAM� c � �ATE_
... .. ; /
APPIZOVAL 1NSPtC;TORS SIGNATUIZ�
llA
�ll�` City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977