P - 44998- From: City of Fridley To: 7637816681 Page: 2/4 Date: 5/27/2009 12:30:38 PM
Building MECHANICAL Permrt N�.: � � �_U-
Inspections RESIDENTIAL APPLIC�ATION ReCe1VeC� By: i�1 _
, �
?�3-s�2-3604 CITY OF FRIDLEY
76 �-502-4977 FAX Date Rec'd:_ `
- - FH'F�:CTIV�2-19-09 i�i�i�l11 AP1v= n n �.
'v',� Tt_ _�� J ��(�._
�ITt ADURtSS _��
THI> APPLIC`ANT IS:
PROPERTY
O �V N E�R/
TENANT
C01TR�CTOR
�L E3:ti11T A COPY OF
YOUR ST.4TE
LICENSE WITH
APPLIC.ATfON
� V ��OUIt E-MAIL ADD1tESS
1 S
�h----�Vy'NEK 'ONTRACTOR
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NAM�:
AllDRtSS: �� CITY
PHONt: ./G'l�-iril.�.� GVU
COMPANY NAME:
CnNTACTPERSON:
STAT�: LIC�:N'S/�t i�
,4llD12�:S�S: �F.� �%.
PHON�; � (-�'7 - ,
PERti71T TYPE ���NGL� h'AM1LY ❑ T1�'q h'AMILY
�Tl'PE OF W'ORK: � N���� �IZtPLAC'tMtNT
DETAILED DESCRIPTtON OF WORK
�.
�i
L�CP DAT�
C:ITY
h'AX 7�- �%�J 7�
❑ TDWNHOUS�
❑ ALTEKATIONiREMOUEL
IP
STAT�I�
FEES AI2E BASED Ov �IU.O(I PEN FIX"i'URE, �XCEP"' �VHN:RE VO"I'�;D. F1X7'URES: VUICA'f�;'fO'1'AL VU_�ISN;R C)F EACH B�LOW)
r.quipmenr lncralled MFCi: MOD�L:
��- SI'L�ik3TU ��c`q..�
Mh'G: MOUEL:
mrc;:
A C ���.00 -
�,IR TO AIR EXCHAIVGttK �l�
ei�)ILtK 53i.UU
CHl�1h�1' LINtR$fODU
Dl.'CT �1'OKK 510.QU
I�urx�bcr o{fixt�t'c5 C� �S'.1(1,Q�3 x �'IC
t�'u�r�hec of tixtures �`_�r,_�. �1 �.Q€] x $��
i�'urnhcr ot�fixturc..� fa; $25.t}0 x $25
t�ur�bcr:o#'fixtt�ccs � �35 OU _ :E x ��5.
StaiL Surchar�c = ���.$�
(�ll:�l_�IL'�vI EEE �3,_>ni ��r.�i � � 4
MOU�:L:
FiREPLACt (GAS) $15.00
�IZ�PLAC t ( Vr'OOU) $35.00
FURNACE $3�.00
GAS DRY ER $ 10.00
_GAS P1PWG $10.00
SILtiBTU
SI"LtiHTU
GAS RANGEiOV�N $IQ.OQ
NEW GAS CRILL $10.00
GAS UNIT HTK $10.00
POQL HEATER $35.00
_VENTILATOR $ I 5.00
THIS IS AN APPLICATION FOIt A PEIZMiT-NOT VALIll UNTIL PROCtSStD
i hcrcbv applv for a building permit an cknowlcdgc that thc infom�ation abovc is complctc and accuratc; that thc work will bc in
cunforn�ancr ���ith thc ordinanccs and dc.ti af thc City uf Fridlcy and with thc,Minncsota Construction Codcs; that I undcrstand this is
r�ot a permit but only an application f r a permit ana W�r�C (s not to start without a�crmit; that thc work wiil bc in accordancc with thc
a��pro�-cd pian in thc catir of all �u rcquir s rcvicw and�� �roval of plans.
, �
�I<;\.�Tl.lit nF' APPLICAN � INT NAME ��') ����� �. 1 -
DATE � _�.J
PLEASE I�OTE: S�FA�iA`i'� P���S�1tTC;ekG;:o:�i� i:tD:i�ra �:3� r�s�.;x:.:.�:rt�.�.::�.. �.,,»,�._, .._,:.: _..� ._.._._. ........:.._
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
7b3-572-3604 FAX: 763-�02-4977
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