P - 44970Bui�ding
Inspectians
?d3�572-3644
763-502-4977 FAX
From: 7635720164 Page: 1/2 Date: 5/17/2011 8:49:52 AM
MECHA,.l�iIC,�L
R�SIDEII�TIAY., AP,PI�I�CA'�'IUN
CI'�'Y Q�' F�tII�L�Y
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AATE J - I /t ��
SI'� ADDRESS r ✓
77i[S APPLICANf IS: ❑
PROPER'�'Y NAM�:�
d'WNE#t/ ADx3RESS:
TENA�VT �r
ADDR.�SS
�.v,,.,,.�.,na.av,w CpMpAAIYN1IME• •�LFesAt Iir+elei-11YV Q[ A. C..
SUBMIT A COPY OF �NTAC�r �r�sON: FIAYD JQSW�CR
�YOiJR STATE STATE LICfiN3E q ,,,,_ EXP DATE
LICENSEWITH ,�D�s:7221 �Univer�itv Ave. �I E crrv
APPLICATT4N PHONE _.._ 763�- �272, Q�,r2,�_ FAX 763- ��
�'ERMIT Tx'PE
T'XP� �QF Wt)�tK:
�TNGLE FAMIi,.Y ' p TWO RAM[k.Y p TOWNiiOUSE
�4C8M�NT � C] AL'f�RATIONJR�M4DEL
bErAU.�p pfiscx�rtoN o� woxx
ved By:
55432
k'��'S ARE BASED ON S10.Ub P�R FDtTU�, EICCEPT WE�:ItE Ti0'Y'�D. RIXTiJRE'S: {avDICATE'�'OTAL N1�MBER OF �1CF1 BE�,OI�►ry '
R�OV[DE HEA'� �.08.4 CAt.C'S PER MANU J A�5�IiAE HAhDBOOK. � '''�'�
Equipsneutlustalted MFG: �,"����;�`" MODEL; S1ZF�TU lDA�
MFG� ,1t'l�Ld . MODEL: SIZE,�7t1
/ MFG: _ _ hfOAEL:
1..A/C 525.00 _FIREPLA,4'E (GAS) SzS.00
a1�IIt TO A]R EXCFIANGE�lt S! S _FI[�P►.AGE (WO�Ja) 533.06
�� �5�� �FURNACE 53S.p0
_,,,CtI1MNEY LUJER SI0.00 QAS pRYSR $f 0.00
DUCT WOttK;10.U4 _ � GA5 PIPWG 510,06
_C3AS RANC
NEw C�.4s
____GAS UNIT
'f1ixS IS AN A,�'YLICATION FOR A FERM(T-NOT VA�,Ip UNT�L PROCESS�[?
TOR
L S►0.�
S I O,pO
S3S.00
i hereby apply for a building p�x»it and I ac�cinvwl�dge t.�at thc in�4ranation abovo is connplete and acnuratq; that the work w91) be in
conforu�ce with the ordin�nces and eodes of the City of Fridley az�d with the Minnesot� Construction Code�; t�at I unde�stand this is
not a permit but only an app 'cat�an �or a per�nik and wor�C is nat to start without a permit; t�at �e work wxll be in accordance with the
approved plan in the case of I work re ' review and approval of pl
SIGTiATCfRE OF APPLIGANT PRlN'f NAM��!`IG� �. 1 1�%Alf�Al D�l1YR �r� / �l
F
�C��/ ` .
C�ty af F'x�idley
uildiug Inspections �epart�ment
643I U'raiversity Avenue NE, Frid�ey, MN 55432
763-572-3604 FA�: 'i63-502-4977