P - 47272Building
Inspections
763-572-3604
763-502-49'�7 FAX
DATE ( [ /
SITE .�DRESS �
THIS �1PPLICANT IS
PROPERTY N:�,¢
O WNER/ —
TENANT -�D�s
PHONE:
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERNIIT TYPE
TYPE OF WORK;
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
__ EEFECTTVE 2-19-09
�
E-MAII,
Ix
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conu�arn� rr.:�¢: Standard Heating ir on oning
CONT,aCT PERSON: ym0
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STATE LICENSE It F � 7 R7d '�(� DATE
aDDRESS: ,.,r,.
PHONE
F�IILI" ❑ TWO F.<1I�•tII,I'
� NE«' �REPLACEA4ENT
DETAILED DESCRIPTION OF WORK
FAX
❑ T0�1`NHOUSE
❑ :aLTER.ITION%REh4UDEL
Permit No. 2� � � C�' ��
Recei�-ed Bv: ��
����°�: ��
ST
ST,1'['E ZIP
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBF.R OF EACH BELOV�
Equipment Inatalled MFG: MODEL: SI7F/g'�
M� ' MODEL: J` J SJZFJgT[J��
MFG: MODEL: SiZFJBTU
_A/C 525.00 FIREPLACE (GAS) $15_00 GAS RANGFJOVEN 510.00
AIK TO AIIt EXCHANGEER $15 FIREPLACE (WOOD) 535.00 _NEW GAS GIZII,L 510.00
_BOII.ER 535.00 �FLJRNACE $35.00 GAS IJNiT g'('R $10.00
CI�fNEY LINER $ L0.00 GAS DRYER $10.00 POOL HEATER �i5.00
_DUCT WORK $10.00 GAS PIPING $10.00 _VENTII.ATOR 515.00
. . ��� �--=�.a �,:�,.,..s.u...��.,�.d�_.____._
AN APPLICATION FOR A P�T-NOT VALID UN'(TL pROCESSED
I hereb�� a lv for a building pernlit and I aclmo��: e ge t the information above is com let d
p e an accurate, that the �r-ork ���ill be m
confo ce -� i e ordin d codes of the City of Fridley and ti,vith the Minuesota Construction Codes; that I understand this is
not a erniit t � pp cati for a pemiit and vvork is not to start with t a pemiit; tl�at the �m�o - t��ill be in acco ance tvith the
app ved pl c e o all wor which requires review and approval of p
SIG _ U : - PRIN'i N.�fE �
-
:�f—a.�" ".�Tr.--xsr a��� n .,,�,. . ... . ,. �
City of Fridley
Building Inspections Department
6431 Universiry Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977