P - 448633Fs�� �
Building MECHANICAL Permit No.: 'UU�
'G
Inspections COMMERCIAL APPLICATION Receivecl s�i y"
763-572-3604 CITY OF FRIDLEY D��'���� �'� ���
763-502-4977 FAX EFFECTivE i-i-aoli
DATE Z 2 �I� YOURE-MAILADDRESS cOtl IC- 1�' %�D2-�nlGrvt�IIM�GNqt9/Ge �Ge�vYL
si�aDD�ss �/7 E� .2H.e� j2� y �i���;ti /�ti� ��'f ��
THIS APPLICANT IS: ❑ OWNER CONTRACTOR ❑ARCHITECT/ENGINEER
PROPERTY NAiv1E: dSd���w ,�p�,Gt,fj�3 !
OWNER/ ADDRESS: ��7 i%S�iO��- � CITY �/Q�-G�i STATE/i'/IIZIPSSY.3Z.
TENANT pHONE^��- 9�%B- 1�,3Z CELL: FAX:
CONTRACTOR COMPANY NAME: �Ah �eii ! �n G .f l�iL
NOTE• CONTACTPERSON: (�m�r� F/r►�t1,/
SEPARATE CITY STATE BOND # EXP DATE:
LICENSES ARE ADDRESS: �J'DD / SG/ebiGG �lc� ffi�. �- CITY �V /ivp<„ STATFy��ZIP�B
REQUIREDFORGAS pHONE: '%r3�sSf�j:-s100 CELL: (pl2•3�0��.�/�g Fnx: ?63f��{�•,S%6�
AND HVAC
CITY GAS LICENSE # CITY HVAC LICENSE # EXP:
PERMIT TYPE � M�LT'I-FAMILY �COMMERCIAL ❑ INSTITUTIONAL ❑ CONDO ❑ INDUSTRIAL ❑ SWIMMING POOL
❑ OTHER
TYPE OF WORK: � NEW �REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK:
�L,�r� - �2 —,�� ,�'e,v/a��s�,� v�' P.r�,rtr� ��J-�� /lvc�iLcp v.+r�
EQUIPMENTINSTALLED MFG: MODEL: D22� SIZEBTU 22 M
MFG: MODEL: SIZEBN
MFG: MODEL: SIZEBTU
tUC DUCT WORK �ROOF TOP UNIT (RTU)
BOILER FURNACE REFRIGERATION
CLASS 1 HOOD GAS APPLIANCE STEAM/HOT WATER HEATER
CLASS II HOOD GAS PIPING SWIMMING POOL
COMMERCIAL KITCHEN POOL HEATER OTHER
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATION: $ 9 �1�0. °p
PERMIT FEE $ �/�, �`3 1.25% OF JOB VALUATION / MINIMUM FEE $35.00
SURCHARGE $ �jF, � � VALUATION x .0005 / MINIMUM .50
TOTAL DUE $ L,$ 6 MINIMUM $35.50
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a mechanical permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance
with the approved plan in the case of all work which requires revie and approval of plans.
SIGNATURE OF APPLICANT :� PRINT NA �( `I//K �� / DATE: 23 ��
APPROVAL INSPECTOR SIGNATURE: E��TI/17r-� DATE:
"� . �?�F,�' .: � ���: , TE P�`; '�` ° :[�'�QLTTI�E. ��T�r P�:CJk�B �`''�. ; � �'
��� n ��
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX:763-502-4977