P - 47790Building
Inspections
763-572-3604
763-502-4977 F
DATE
SI1'E ADDRESS
TFIIS APPLIC.�NT IS:
PROPERTY
O WNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF '
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
�
N.�fE:
�DDRESS:
PHONE:
MECHANICAL
RESIDEI�TIAL APPLICATION
CITY OF FRIDLEY
EFFECTTVE 2-19-09
E-MAIL
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con�.�rn rr,:��: 5tanaarci tieating & Air on ornng
CONTACT PERSON: ym�
STATE LICENSE M _ DATE
PHONE
F.ariIILl' ❑ T�'O F.M�ffL,l'
� �«� �REPL.4CEh,fENT
DETAILED DESCRIPTION OF WORK
CITY
FAX
❑ TOR?NHOUSE
� AI-TERATION•'REMODEL
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Per►nit No.
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STATE ZIP
FEES ARE BASED ON $L0.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMgIIt pF EACH gELOVh
Fquipment Installed MFG:
MODEL: Si7F1R1'�j
�C' MODEL: �
SIZFJBTU
'✓ A/C $25.00 �G� MODEL:
PLACE (GAS) $15.00 5���
_AIlZ TO AIIt EXCHANGEER $15 FIREPLACE CT� �NGE/OVEN a10.00
BOII.ER a35.00 (WOOD) $35.00 _NEW GAS GRII,L 510.00
CI�IIVEY LINER S 10.00 —F�NACE $35.00 _GAS IJNIT HTR $10.00
DUCT WORK $10.00 --G� DRYER $10.00 POOL HEATER �35.00
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_GAS PIPING $10 00 _VEIVI7LATOR $15.00
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THIS IS AN APpLICAT[ON FOR A PERM[T-NOT VALID UNTfI, pRpCgSSED
I hereby apply for a building pernlit ckno�4ledge that the information above is complete and accurate; that the u�ork tvill be in
conformance = ordinauces codes f the City of Fridley and ��-ith the Minuesota Construction Codes: that I understand this is
not a pe but }• plicati for a pe it and work is not to start �r�ith t a permit; that the rvo t3-ill be in acco ance �vith the
approv plan ' of all rk wluch equires review and approval of p .
SIGNA U_ p jC a v �
PRIN'I' N.�tE
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City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977