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Inspections �SIDENTIAL APPLICATION Received By�feTr'
763-572-3604 CITY OF FRIDLEY ��e� � ���;
763-502-4977 FAX
, EFF'ECTIVE 2-L9-09
DATE �t!j �� L7�
SI'CE .�DRESS
THIS APPLICANT IS: ❑
PROPERTY N �:
OWNER/ aDDRESS:
TENANT -
PHONE:
YOUR E-�, ADDRESS
�
STA�'i/ J`� ZIP
CONTRACTOR �o�;�.�. N,�¢_ Standard Heating & Air Condfiontng
SUBMIT A COPY OF
CONT,aCT PERSON: ymo
YOUR STATE STATE LICENSE 1€ F 1 7 1R7d_7E� DATE
LICENSE V✓ITH ,�DRESS: CITY STATE ZIP
APPLICATION
PHONE FAX
PERMIT TYPE IJ�SINGLE F,�.I�•IILl" ❑ TlVO F.�IILI'
TYPE OF WORK: I � ��L' �PL.4CEI�-fENT
DETAILED DESCRIPTION OF WORK
❑ TO WNHOUSE
❑ .aLTERA.TION REh40DEL
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBII2 OF EACH BELOVI�
Equipment Installed MFG: MODEL: SIZEJBTU
MFG: � MOD ��� SIZ.EBTU � Os��
A/C $25.00
AIR TO AIIt EXCHANGEER $15
_BOILER 535.00
CfiII�fI IEY LINER $ L0.00
DUCT WORK $10.00
MFG: MODEL:
FIREPLACE (GAS) $IS.00
�FIREPLACE (WOOD) $35_00
FURNACE 535.00
GAS DRYER $10.00
GAS PIPING $10.00
SIZF/BTU
_GAS RANGE/OVEN 510.00
_NEW GAS GRILL 510.00
GAS UNIT HTR S 10.00
POOL HEATER �i5.00
VENTII.ATOR $15.00
THIS IS AN ��FE9i►I FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building pemiit and I ackno�a ledge that the information above is complete and accurate; that the �;-ork �vill be in
conformance �vith the rd' es and c of the Citv of Fridley and «�ith the Minnesota Construction Codes: that I understand this is
not a perniit but o� an p on f pe it and w°ork is not to start with t a perniit; that the �vo ttrill be in acco ance �vith the
approved plan in e case �a��uor 'ch re uires review and approval of p a�s. . ,� �% � f
SIGN,4TIJRE UF
N_�fE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977