P - 48071Building MECHANICAL
Inspections RESIDENTIAL APPLICATION
763-572-3604 CITY OF FRIDLEY
763-502-4,977 FAX EFFECTIVE2-19-09
DATE ��
SITE ADD S �
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
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❑ OWNER ONTRACTOR
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Permit No.: L
Received By:
Date Rec'd'l
CONTRACTOR Co1�rnANY N,�: � / � �ehrcS�- 7t.�J
SUBMIT A COPY OF ��TACT PERSON: � f2 _//
YOUR STATE STATE LICENSE # DATE
LICENSE WITH ADDRESS: ` �� � Lv� fiCI Y� /,�/L� STATEI-"n,ir�.S�
APPLICATION pHONE�� /�' f L/ ���`j�' FA7t
PERMTT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � NEW PLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK
,
FEES ARE BASED ON $10.00 PER FIXTURE, E PT WHE FIXTURES: rCA OTAL NUMBER OF EACH BEL
Equipment Installed MFG: �� MODEL: ��7Q' � SIZEBTCT
MFG: / MODEL: _�� SIZE/BTU_,��Vv�
�A/C $25.00
AIR TO AIR EXCHANGEER $15
BOILER $35.00
CHIMNEY LINER $10.00
DUCT WORK S10.W
MFG: MODEL:
FIREPLACE (GAS) $15.00
IREPLACE (WOOD) $35.00
FURNACE $35.00
GAS DRYER $10.00
GAS PIPING 510.00
SIZF/BTU
_GAS RANGFJOVEN 510.00
NEW GAS GRILL 510.00
GAS UNIT HTR $10.00
POOL HEATER 535.00
VENTILATOR $15.00
THIS IS AN APPLICATIQN FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit ac ledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and s th City o Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an applic 'o p rmi and is not to start without a permit; that the work will be in accord ce with the
approved plan in the case of a w k i re ire view and approval of plans. �
SIGNATURE OF APPLICA , . � _ ��! ' ��� `�'�°' ��`��"� �! 7% � ��
" City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
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