P - 44842Building
Inspections
763-572-3604
763-502-4977, F
DATE�
SITE �DRESS _
'fHIS ?.PPLICANT IS:
PROPERTY N�: ,
OWNER/ aDDRESS:
TENANT
PHONE:
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERNIIT TYPE
TYPE OF WORK:
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTii%E 2-19-09
�
�
Permit No.
Recei�-ed B�-:
�.�:�'1
C'OniPANl' N.�fE: ..,.a��...,.., � �......,.y .... ... --••-•..-•----.-
CONT,�.CT PERSON: Ym0
STATE LICENSE # F 17 ,R7d_7F75`� DATE
?�DDRESS: CITY STATE ZIP
PHONE
o rrEtv
FAX
F,4IvIIL1' ❑ T�'O F.AI�IILi
•PLACENfENT ❑ 2�
DETAILED DESCRIPTION OF WORK
❑ TOUNHOUSE
FEES ARE BASID ON E10.06 PER PTXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL N[JMBER OF EAQi BELOV1�
Equipment Instalkd MFG: MODEL: SIZFJBTU
MF � MODEL: �C��� SI7.FJBTU ���CJ
MFG: MODEL: StZFJBTU
_A/C E25.00 _FIREPLACE (GAS) 515.00 _GAS RANGF/OVEN S10.00
AIIt TO AIIZ EXCHANGEER S15 FIREPLACE (WOOD) 535.00 NEW GAS GRILL 510.00
BOILER 835_00 �FURNACE 535.00 GAS UN1T H1R 510.00
CI�INEY LINER 510.00 AS DRYER $10.00 POOL HEATER 535.00
DUCT WORK 510.00 GAS PIPING 510.00 VENI�,ATOR 815.00 .
THIS IS AN
VALID UNITI, PROCESSED
I hereby apply for a building pemiit and I ckno«�ledge that the information above is complete and accurate; that the ���ork will be in
confonnance with th dinances and c s o the City of Fridley and ���ith the Minnesota Construcrion Codes; that I understand this is
not a peraiit but o y an � tion fo a pe t and work is not to start ���ith t a perniit; that the �vo � c3=ill be in acco ance �vith the
approved plan � e cas o I ork 'ch r�uires review and approval of p . �
SIGNATURE OF _ LIC_ PRIN"C N�4E T 1 L�{ _� I n�l �TET'T7 \ ` �`�/ �
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley,lNlN 55432
763-572-3604 FAX: 763-502-4977