P - 36953.� �� `�_v ,� ��, , , ,�, , From: unknown Page: 2/2 Date: 11/10/2010 9:51,:49 AM , � , , , . `
Building MECHANICAL permit r�o.•
Tnspections RESIDENTIAL APPLICATIUN �eoeived By
763-572-3604 CITY OF FRiDLE'� °at��:
763-502-4977 FAX F•Fh��'nv�:2-iv-o9
DATB��»���p YOURE-MAfLADDRESS dave�davesheatingandair.cam
S1TE ADpRPSS g150 KEf2RY LANE
TIi1S APPLICANT tS: f3 4WNER l7CONTRACTOR
PROPERTY NAME: GHARLES BURNSIDE
OWNCR/ qDDRCSS:61$pKERRYLANE ��TyFFtIDLEY sTATgMN zrr�32
TENANT 763-571-0821
PHONE:
CUNTRACTOR CpnqppNy �pM�: DAVE`S HEATING, AIR 8 EI.ECTRiC
SUBMi'i' A COPY OF ��'ACT PERSON� �Y MADVIG
YOl7R STATE STAT6 UCENSE # EXP DA'f6
I.ICENSE WITH ADDRESS: �$0137TH AVE NE C►TY GOLUMBIA HEIGM'S STATE � ZIP �21
APPGtCATfON PHOIYE ��'781-6901 FAX 763-788-8805
PERMIT'I'YPE �NG46 FAMILV ❑ TWO FAMC[.Y O TOWNNOUSf
TYPE OF WORK: Q NEW �PLACEMEMT L] ALTERATIOM/REMODEL
DETAILED DBSCRiPTION OF WORK REPLACE FURIdACE W/ LENNOX M#G71MPP-38G�090
F�FS ARE BASEp ON S10.OQ PER F(XTURE, �XCEPT WHERE NOTED. FIXTURES: (INDlCATE'fOTAL NUMBER OF F.ACN BEIAVI�
Equipmentlnstelled MFG; �� MOD�I.: a*+�'�080 31ZNJBTU 0770D'°0°
MfO: MODEL: SlZUH7'U
MpG: MODEL: S12RJBTU
C S2S.00 _,.,,P11iEP1,AC� (QAS) 515.00 GA3 RANCiN1pVEN SIO.�
IR TO AfR EXCHAT3G46R S15 REPLAC6 (W04D) 535.00 NEW GAS GRILI. S19.W
BOIT..ER S35.00 ACB 535.00 OAS tft�11T FITA S 10.00
CHIMNEY LtNT?R S10.Q0 AS QRY�R 510.00 POQI, HBrITEA 535.00
DUC7' WaRK S 10.00 GAS PI PINQ S 10.00 V8NTILATOR S I 5.00
Numbor of tixtures (� 510.00 x$10.04 ���
Numbcc of fixturts (�a $15.00 x S15.00 = S
Number of fixtu�es � 525.00 � x S25.QQ � S_ ___
Number of t3xtures ��35.00 '� x$35.00 �� 35.Oa
S�ate Surchargt � $ •50
MAVI.MUM FE� S3�.S11 1'otet = � .
77�US 1S AN APPI.iCAT'ION FOR A PERMI'T NOT VAI.IA UNTIL PAtOCE338D
1 hereby apply for n building permit and 1 aclrnowledge that the information above is complete and accurate; that the work will be in
conformsnce with the ocdinances and codes of the City of Fridloy and with the Minnesota Construction Codes; that ( understand thls is
not a perm�t but onty 4ication for a pennit asxl work is not to start without a permi� that the work will be in acco�+dance with the
approved plan in the e o. 1 work wh'ch uire. re iew and approval of pl ns. t
SiQ�NATURL' OF APPLI PRINT NAMB ,� pA'� 1���., .�-.—
LEASE NOTE: SBPARAT6 P� I'1'S ALtE RE �D FOit BEJILDFNG BL�CTRICAL A GHANrICAI� WORK
C:ity ot .�'r�a�ey
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
7b3-572-36Q4 l�A?C: 7'63-502-497?
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