2007-01082 City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-502-4977
6431 University Ave NE
Fridley MN 55432 Mechanical Permit �'��
Commercial Application
City of Fridley RECD JUN 2. 1 2007
Date -7-1-07 Site Address:-/-5-6 0 6 -1�7 il/ 6 — -1,-LQ
The
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The applicant is: (cirlce one) Owner ontrac Architect/Engineer
Property Owner: &(.'f7&S
Address:
City: State: Zip:
Phone: Cell: Fax:
Contractor Information
Company Name:
Contact Person:
Address: F-
City:lt�-/LStater Zip: �sC72�
Phone:(v�si�Cll�G Z,22f Cell: /,/ 2--6�,5.2-.39'S Fax: 6�%=
Email: MN Bond#& Exp Date
Permit Type (circle one): ulti-fami Commercial Institutional Condo building
Industrial building Swimming pool Other:
Type of Work(circle one): Newlaceme Alteration/Remodel
Detailed Description of work: �iSCo,c �� _ ��� S /-b VlC-
Equipment Installed: MFG: Model: Size/BTU:
MFG: Model: Size/BTU:
MFG: Model: Size/BTU:
Please check all that apply: _Duct Work _Roof Top Unit(RTU)
A/C _Furnace _Refrigeration
_Boiler _Gas Dryer _Steam/Hot Water Heat
_Class I Hood _Gas Piping _Swimming Pool
_Class II Hood _Gas Unit Heater _Temporary Heat
_Commercial Kitchen _Pool Heater _LOther 57-a,vC
All fees are based on valuation, including the cost of labor and materials:
Total Job Valuation: $
Permit Fee $ �� (1.25% of Job Valuation / Minimum fee $35.00)
Surcharge $ Valuation X .0005
Total Due $ 0. .D , Make check payable to City of Fridley
This is an application for a permit- not valid until processed
I hereby apply for a mechanical permit and I acknowledge that the information above is complete and
accurate;that the work will be in conformance with the ordinances and codes of the City of Fridley and
with the Minnesota Construction Codes;that I understand this is not a permit but only an application
for a permit and work i of to start i h a per Sn';that the work will be in accordance with the
approved i ca rk whi requires rev' and approval of tans.
Signature of Applicant: Date: �1
- 07
Approval Inspector Signature Date: -Z57
Please Note: Separate permits are required for Building, Plumbing, and Electrical work
Revised 6/14/2005