P - 59366Building
Inspections
763-572-3604
763-502-4977 F
DATE L
SI1'E .�DRESS '�
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TFIIS APPLICANT IS:
PROPERTY
O WNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
A.PPLICATION
PERMIT TYPE .
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTT�-E 2-19-09
�JFOURE-MAII.�RESS —
i//t _ 1 _ A
❑ O��NER _
c
Permit No.0
Received B}
Date
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N.�: (
aDDRESS: C ST� Z���
PHO�: — y
�_on�.:�. N.,,�¢: Standard Heating i� on ontnq
ymo
CONT.�CT PERSON:
STATE LICENSE 1# R 1 � R7d 7F�,fik� DATE
ADDRESS: CITI' STATE ZIP
PHONE
F,aI�IILl" ❑ TR'O F.�III.1'
TYPE OF WORK: I❑ r��v �x�rL�cEn-�NT
DETAILED DESCRIPTION OF WORK
FAX
❑ .u.
❑ TO�S•`NHOUSE
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBIIt OF EACH BELOVI�
Equipment Installed MFG: MODEL_ SIZFJBTU
MFG: � MODEL: _ C / '1 SIZFJBTU ���y'`
,�—
MFG: MODEL: SIZFJBTU
C 525.00 PLACE (GAS) $15.00 GAS RANGE/OVEN 510.00
AIl2 TO AIIt EXCI3ANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRII.L 510.00
_BOII,ER 535.00 FURNACE $35.00 GAS IJNIT H'IR $10.00
_CHII�IIJEY LINER 510.00 GAS DRYER $10.00 POOL HEATER 535.00
_DUCT WORK $10.00 GAS PIPING 510.00 VEIVI�.ATOR 515.00
� - THIS IS AI�TAPPLICATION FOR A PEIZMIT-NOT VALID UNI'II, PROCESSED
I hereby apply for a building pemlit and I aclaia�y�ledge that the infoanation above is complete and accurate; that the �i-ork �vill be in
conformance �vith the ordinances an es of the Citv of Fridley and ��-ith the Minuesota Construction Codes; that I understand this is
not a perniit t onl}' an applicat� o a miit and work is not to start �t•ith t a perniit; tl�at the �vo r c�-ill be in acco ance �vith flie
approv an of all rk �c requires review and approval of p
SIGN.� iRE _ PRIN'I' N�fE T 1 L�{ _/� ln�i�CI'L�'1'j \ ���. �/�
City of Fridley
Building Iaspections Departmeat
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
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