P - 48543BU11C�1i1�
Inspections
763-572-3604
763-502-4977 FAX
MECHANICAL
r�sID�NTrAL aPPI�ICaTroN
CITY OF FRIDLEY
EFFEC'iI�-E 2-L9-09
DATE �S I CP I I z•
SITE .�llRESS �
THIS _�1'PL[C.-�NT IS: ❑ O��NER
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
,v�PLicaTioN
PERNIIT'TYPE
TYPE OF WORK:
N.�dE:
_'�DDRI:SS:
PH�IV�:
YOUK E-MAIL ADDRF„SS
�!I
�I�'1'R�GTOR
�
��- �- �
Permit No.: ���Z L��'�
Recei� ed B� f ��t�'
�����:�-e � � � ll'3 �,
��n:�a�. N�¢. Standard Heating 8� Afr Condfioning
corrr.acT YcxsoN --- ��-Plymoutn Avenue t�f�srth ___ --
- -fvltttflea�olis� P�i�-5�4a-a-�44� — —
STATG LICENSE I# __ F � 2�24-2��� DAT'G
PIiONE
F;aAQLl' ❑ T�'O F_-1Ir� 1'
❑ NE�i' �PL.�CE�tENT
\
DETAILED DESCRIPTION OF WORK
CITI-
['AX
❑ TO�iNHOUSE
❑ TER.aTION:REn10DEL
��-c �Yl� �� �-t
FEES ARE BASED ON $10.00 PER FIXTiJRG, EXCEPT WHERE NOTED. FIXTURES:
Equipment Installed MF�G: MODEL:
MFG MOD�L:
�G= MODGL:
�A/C $25.00 'PLACE (GAS) $15.00
AIIZ TO AIR EXCHANGEER $15 N'IREYLACE (WOOD) $35.00
BOII,ER 535.00 �(FIIRNACE $35.00
CIIIMNEYLINER$10.00 � CC'ASDRYER$10.00
DUCT WORK $10.00 UAS YI V[NG S 10.00
TL' ZIP
(INDICATE TOTAL NIJMBII2 OF EACH BELOVI�
SI7_.F1BTU
cJ �_� SIZEJBTU�.�V "\�
� SIZF/BTU �
GAS RANGF/OVEN $10.�
NE W GAS GRILL $10.00
GAS UNIT IiTR $10.00
POOL HEATER S35A0
� VENI7LATOIZ �1_5.00
I'HIS IS A1�d A1 1'I IC:AllON�F��A YI?I�ivll'I'-NO�I� VAI,ID ON�1'II, YROC'ESSF?t>
I hereby apply° for a bttilding peinut and 1 ackno��ledge that the viformation above is complete and aecurate; that the �r�ork ��ill be in
conformance �eith the ordinances and rode e Cih� of Fridley and �.�ith the Mionesota Construction Codes: that I understand this is
not a pemiit but orily an �� tion fo it d t�°ork �s not to start �� ith t a perniit: that fhe ��vo �«�ill be in acco ance �.vith the
approved plan in the e o 1 k h r es view and approval of p �
SIGNATURE OF APP _ PKIN"I N�fE �( %�-
City of Fridley
�uilding Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977