P - 42099Building
Tnspections
763-572-36p4
763-502-4977 FAX
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SITE ADDRESS!
THIS AP?LICANT IS:
From: 7635720164 Page: 1/2 Date: 5/18l2011 10:05:14 AM
��C�ANICAL
RES��►ENTIAL APFLICATION
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�-MAIL ADA�855
QWN�R/ ADDRESS: . ^
i'�I�iANT
PHONE:
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Perm�t No. _
R�c��ved By:
Date �tec'd:
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ti.vA��au+a..xv[� G'QN�ANYTl/1i�E: raw,ru�i uycaa�.a.L�v a ra.ti..
St)814tCC A COpY dF cOivTAGT P�RSON: FLOYD JOSWICK
Y�UR STATE STA,'I'L' LiC81�5E # EJO� DATE
��sfi� :a,n�n.FSS;72�t Un3.versitv Ave. 1�.�, ct�r�r F�a.d�,ev �,STATEMN Z1F 55432
,4�P�.ICATIQN �� 7��_5.72-0459 FAX763-572-0764 � .
PERMIT TY�'E
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�SINGLE �AMILY D TWO FAMILY
o r��w d �rLacE�rrr
UETAILED I�ESCRIPT70N OF WO1ZK
C] TOWNHOUSE
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F�+E9 A� BAS�A ON S1G.00 PER Pl'�iiJRL. �CG'�PT WHERE NO'C6D. FucTURESe (1,NDIC,#7'E TOTAL CvuMBE[t OF �AC� 6EL0'W)
Y�OVIDE HEA'a' Lp6S CA�.C'S F�lt MANUAL J 2006 ASFIRAE Y�IA.NDB40k.
Equipnt�t Inatalle� NifG: MODEL: �� SIZE+rBTU
1�FG: MODEL:
MFG: MODfi[.;
A/C 525.00 _FTREPL.ACE (OAS) 315.40
AiR'PO AIIt EXCI�WI�F,.�R �IS _F3ItEPLACE (WO�D) 534.00
$OxI.�Ct �35.Od _FL1TiNACE S#5.00
CFi1MNEY LINER SiO.Od GAS DRY6R SIU.OQ
DUC'f WORK Sl0.00 �(3AS PIPMG S10.OQ
SIZF�B�1J
GAS RANGFJ�VEN tl0.0(
TtEW GAS GR LSlO.DO
GAS UNIT H 5�0.00
POOL HEAATF,� 535,00
_VETITIG.ATORi515.Q0
�HIS [S AN APFLICATION FOTt A P��IT-NOT VAL[L� UNTIL PROCESS�[}
I her�by apply for a buiiding permit and l acknar�►+ledge that the information above is cor�aplete and aocurat$; that the wark wi31 be in
co�formance with the ordiz�aACes and eodes o� thc City o� F�idley and with thc Iviinnesota Cons�ructian CodQs; that I understand this is
z�ot a permit but only a», eppliCati for a permiy�a�qd work is not to start wirh t a permit; that thc wa�k will! bc i� accordance with che
$pproved plan in the cgse of all wark hich re `� cs review and approval of p1 s. �
SIGNATLfRE 4F APPLZCANT . �'Q�! __ PRINT NAME 1�I i, �� �n�� ����� I
APPROVAL INSPEC?Ok$ SIGTIATURE
c�ry �f ��a��y
�uil,ding Inspec�ions Aepartment
6�431 University Avez�tue NE, Fritlley, MN 55432
7�3-5'72-36Q4 FA,�: 763-502-497'7.
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