P - 84393z� z
Building MECH�iNTCAL �'�r�itNo.: U
Inspectians RESIDENTIAL APPLICATION Received By:�
763-572-3604 �ITY OF F`RI�.IIIEY
763-502-497? FAX „��.,M...,� . , ,�., t���`"��"'
DATE__�� "1 ! l-
S1TE ADDRESS
THIS APPLICANT !S�
OWNER/
TENANT
SUBMIT A COPY OF
YQURSTATE
L1eENSE WiTH
APPLiCATtON
FERMIT TYPE
TYPE OF WORKs
YOUR 6-MA1L
❑ QWNEIt �`1CON'fRAC'fOR
ADDR[SS: � w�.l . CITY,
�HOt�E• "7�0 3" ';�S�S' �f��S �
coMra,NV rrnMe:,_,_ Kline Corp.
coNrncrrcRSOrr:_ DBA: Practical Systems
STATE LICENSE #_ �3�i'2B SitaC�y �ak �Oc�d
ADDItE3S: HQ(JiCIiS, MN 55343
��o�� 952-933-4868 x �Ua"
�rYSWGLG FAMILY O TWO �AMILY
❑ NEW 0 RLPLACiMENT
DETAILED DESCRTPTION OF WORK
❑ TOWt`(HOUSE
Y�7A�TGItA7'fONfREMOQGI.
� ���.
STATE ZIP
�e,^' ,<��1..% �'�x}�'
_ �'J
FEES ARE BASED ON 510:00 PER FIXTiJRE, EXCEPT WwIERE iVOT�D. F[XTURES: pNDICATE TUTAL tVUMBER OF EAGIi RELOV1�
PROVlDE ilEAT LOSS CALC'S PER MANUAL J 2fl06 ASi[RAE NAiVDDOOK.
Equipmenl {nstalled MFG: �.,�.�v"'1" MOAEL: �r_ '��7'� �.I��=. SIZE!(3TU J 1— C5 �
NC $25.00
AIR TO A[R EXGI-1ANGfCR S I5
BOILER 535.00
`CHIMNEY LINf R $10.04
Dt1C1' 1WQRK $lO.Op
MrG:
MODEL:
MFG: MaDEL:
_j,_FIREPLAG@ (GAS) S I 5.00
fiREPLACE (WOOD) $35.00
�URNACG 535.40
GAS DRY£R $14.00
SI2UDTU
S[ZEJBTU
GAS ftANGF10VEN $10.U0
NEW GAS GR[LL $iO.OG
„�GAS UN1T IiTR $IU.00
�NOOL tIGATER 535.0�
____ VGNTILA'fOR $I5.00
TF�IIS 1S AN APPLICATION FOR A PERM[T-N07' VA[,IA UN'fIL �ROCESSED
1 hereby apply for a building permit and I acknowiedge that the in€ormation above is complete and accurate; that thc �vark wili be in
confarmance with the ordinances and codes af the City of Frid}ey ar�d with the Minnesota Construction Godes; that T understand this is
not a permit but only an applicatian for a permit and work is not to start ithout a permit; thai ti�e work wi:il be in accordancc with thc
approved plan in ihe case of ati work which requires review an�l approv�f plans.
SiGNA'E1JRE O� APpLICANT
T, 10T.-/ 1-(1 L
� City of Fridley
Building inspections Department
6431 Liniversity Avenue NE, Fridiey, MN 55432
7b3-S72-36Q4 FAX: ?f3-502-4977
LO R�-�i l
Wd £0�9 6� 6 L Z 40Z/L l/0 L:a��Q Z2 :a6�d 699 4££6ZS6 :�o��
B9R IFF,Fi7.Gfi