P - 44990From: City of Fridley To: 7637816681 Page: ?J4 Date: 5/27/2009 12:30:38 PM
Building MECHANICAL Permit No.: 1�
lpspe�tions RESIDENTIAL APPLICATION Received By:_t��
763-572-3604 �`°" ---
?63-so2-49�� Fax CITY OF FRIDLEY �L � ° ���i:� � ��10 _
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TF11� �PPLICANT IS�.
PROPERTY
OWNER'
TENANT
CONTRaCTOR
S� BtiilT .� COPY OF
YOU ft STATE
L[CENSE WITH
APPLICATION
PERti91T TYPE
YpUR 6-MA1L ADDRESS
t�P t�C�,�'_ 1�1 �
❑OWNtR �CONTKACTOK
NAME: /
A(�URtSS: �j
PHONE: �„�-
CQMPANY NAME:_
CnNTACTPERSON:
STAT�: L1C'�N�/S�� i!
AllD12�S�S: lF-� 7
PHONt � /-�"7 - �
SINGLt h'AMILI'
❑ TWO FAMILY
TYPE OF «'ORK: � N��� �i`�ZtPLACtM�;NT
DET.�L^'ED D�ESCR1PTtON OF WORK � t,LL/�
Jf'��-G CITY
1�- -
P DATE
CITY
r�,ax7/,,�- %ci�I7�� -�
❑ TOVr'NHOUSE
❑ ALTE1tATIONiREMODtL
ATE ZIP
AT � t���� �!�
f EES AR�; $AS�;D OV a10.00 1'ER F!X'1'UR�; � CE!'"' W�;R�; VO'1'�;D. F[X"I'URN,S: V CA"'E .I. )..AL VU�IBER OF �,ACH LOW')
t �iiipment Instailed Mh'C;: �' ��"y�� M(�UtL: ��'� �
J SI"L,�iBTU ��
MNG: M011EL:
Mh'G:
A �C $��.OU -
�AIIZ Tn Allt tXCHAIVGt�R $15
_ k��IL�l2 S3�.fi0
_ C'HIMNEY LINER$10.00
llI;CT WqKK $ IO.UO�
�urr�bcr o#'fixt�r� Ca� �IO,ti� x �li�:
?���mbcr uf tExtures �� � 15.0€i x$�5.
f�'umbcr ��f fixt�an„� fu�, $25,tI0 x 25::
- ---_ $..
!�"i�rnbcr offxt�res f�' ,�:35AU f x ��5:�
Stats: Surchar�c = � �:�j
(%11�iI�IL7�I EEE 535_�f�t Tnr.a1 � T� `
MC)llEL:
FIREPLACE (GAS) $15.00
�h'11ZEPLACE ( WnOD) $35.00
�NURNAC�; $35.OQ
GAS DRY�R $ IO.OQ
_GAS PIPING $10.00
=� <
SIL�iBTU
SI'L�.i13TU
GAS RANGEiOVtN $10.00
NEW GAS C;RILL $10.00
GAS UNIT HTK $10.00
POOL HtATtK $35A0
_V�NTILATOR $I5.00
THIS IS AN APPLICATION FOR A PERMIT-NnT VALID UNTIL PROCtSS�D
( hcrcby apply for a building permit an cknowlcdgc that thc information abovc is complctc and accuratc; that thc work will bc in
,onformancc with thc ordinanccs and dcs of thc City of Fridlcy and with thc Minncsota Construction Codcs; that I undcrstand this is
nor a permit but only an applicatian f r a permit anc����C js not to start without a permit; that thc work will bc in accordancc with thc
a�provrd plan in ihc casc of ati � o "rc;yuiry,s rcvicw an7'�a roval of plans.
�iG\ATI,R� Oh� APPLICAN � � liC<- INT NAM� � '�� � ��� pAT� ��� � �
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977