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P - 42275From: 9528370086 Paqe: 1/7 Date: 3/26l2010 1:38:08 PM inar.Ll�.GUlU 1G:�4 YLvl '1'H� L�LUL�1tj11Vl� YttC3� LLl: y5G2i.S/UUtS[� �uild�n� Inspectio;ns 7G3-572-3G04 763-502-4977 FAX 1V�.��.A,.�ZCAL RESIDENTIAL Al'P�.xC,ATI.0�1 C�TY U�' k'R�DLEY �ATF... _ YUUR �MAIL ADllF�SS 3ITEAnDRF,SS �+%6!.._........5�.-- �--._...�`!� T1-I[$ AppLICANT LS: O UWNEI{ �]CONTttACT4R O'UVNER/ TENANT SULiMI'f A C:t]I'Y OP YQURSTATG �.iCEIVSE WITH APPLIGATIUIV rx��. l� Pcrmit No. Recei�vEd By: D�� i� 1VAME: A�nRE4S; ~ ...-.....,.. �.lTY STATE ZiP PHONH: --•-..-.-_--....... _ . CQMPANY NAME� HG U^~" ►. /� L C CONTACTPCRSON: S'!'A1� LICGNSC N I�% �^ (11 EXP fiATE �'Z -J�jr" I� ADDRES3: �'% � �l V�"S/�/�1 t�.� � CITY_ 4 �1G �O�STATF��+��7..1P, PIiONE �n/Z i0� SZ�,� FAX _�S'�- S�'� [7��to PERMIT TYPE � SIN4�.F �aMt],v � �Wp FAMiI.v TYPE OF WORK: {] N�W �FL�3'LAC:f;Mk�.N'f p�TAILED DESCRIi'T10N OF WORK 0 Ti�WNH6USE O AL1'�RATIONlREMdDEI. i+LSSAR$ BA3ED ON S10.Q0 PRR FIX71)RR, FX('.F.PT WHF.RF. TVtYi'F.D. RIXTIIRES: {INDICA'1'E T'UTAL NUMSLR OF �A(:H BELqW) PROVtDI� HEA'1' L�4�S5 GAI.C'S pER MANi1A J 20 G .HRAE HAPlDSOOIC. Fquipmcnt I�alicd MP'C;: � /r1 MOUEL: C� SIZF.BTU �d/ �v MFG: MObEL: S17..F.lBTU MFG: r � MODEL.: SIZG/BTiJ _NC 525.00 �FIREPLACL� (IiAS) �13.W GAS 1NNGfJOVEN 510.00 AIR TO AlR EXCHANCrF.F.R �1 S, FIREPLACE (WCK1D) S35.W NBW GA$ GRfLL $10.00 ,�,�i$OILER 535.00 �� FI.lRTtACE 535.00 GAS UNIT iITR $E0.00 CI[IMNGY LINER $10.00 GAS DRYFR $IO.W l�UUL HEA'tETt $35.00 _DUC'i' WORIC Sl0.00 _ _ljAS i'iPIA1� S fO,Ob Vb'N7'ILA'iOR 515.00 �m � .,t��rl. •r`� ...,.,, - . . .. - . ,.;. •.... ,., ., ., . ,: ., -. .. , �• �° ,. . ,. - •. � . . , . . . . .. , ... �.---t• . • . � .. .: ....•. : ' t. . . r :...... .. . ... .:.. . � .. �. . ::• . . .: .; . . .. . . :x.wa x �... ..., • ': 1 : � • � , , '.; , �' ^w ;. . , , . ... • . ,,;:, • 'a'. - . ;Y�...,•r�:,:•4: � ' - ",}•,�• .. t�. "..,. .' ' , .„ , .'i�'F.:. _ �.� i. ;�,;a..�' r, � � . . � .: !'�y�:�.,,,�:�A'�' � "��„e�:,,�"•�3 �:+•v�.,�� r� k:.-;Y: ��'�'t:J'.:;}�.�`�*.I. : �. � ' ;' � .: �,. �:�' .: . ., � � ^ � ' A ' r�• � �I{��, e. d ::,''r,��•_•,' �'.� '�•'• x� r , , „ . . f ��:��. ��t;.�`' ^�:''�' ��' ..�. a '"•''^' •"r"�^"K �•.y;.� ��xn• � l{i . .i.. `�• .4.� 'a�.,..::� '� } �' •• f � �+ 2. �.. . _ ."��3; p! •7 � . ' X' � �' +' t . �. � . � - '").�: . ' ' + �`�i�;};:6" 4�!"' e i�.. �r . .. .�r... . - •f ' �'✓. , :.�,..::•. ti'� • .J.� �A41il�Z�� lt+„wV„ . k�.�•r:� '�:,,; ••.:'• •'� .. yl v �.. . �.. . . ...•.:�` � Y�.. +'v'�'�:..:. ..........��.:.,:�:�., :. .,�--s:.. . � i.•. :�a��.' •;e'�' . :e.: �.!'.H`{.'.,t ... ..a' '� ^� •� " ,".'..x��' f�.�. �~".�.L�„� .e �,.: •.....'y:.;. � ' , '� , � - . <.::. •... . � v,�v'.:::,.,:;..,,.. :•:?�.'':,..:{,: �r,: ��...• .�� }•,�?�� i:i:.. �,^.'{:.:a �•'�.,.�;. . . 5��." 'a��n.` ... ";a;;' ;:.''' � , .' , . . .. . ,. , , ' �, . :y• `. . . , .... �_ ; .. , .. ; ,... .;.. _.., :... ' .��'.�� .. . . • , . T[IIS IS �N APPLICATION FOR A PERlvt[T.NpT VAIJD UNT1L. PRC�CESSF.4 i here[�y appty for a building pernlit and I acknowlcdgc that the informstion �bove is complete and accurate; that the work will be in conformance with the ordi��anccs and codes of the City of Fridley and wit� the Minnesota C:onstruction C:odes;'that 1 understand this is not a perntit but only an application for s permit and work is not to start without � permil; t,het the work wil} be ia aacordance witb tha approved plan in the c�se oi work which requires revicw and approvel oCplAns. S�4NATURE OF APPLICANT � PRINT NAME �''}_pq'�'F, �U '� �- �' I� City of Fri�ley Building Inspections Department 6431 [1niv��sity A,venue NE, ��ridley, .MN 55432 7C:i-572-.ifiO4 FA?C: 7E�3-5U2-4y77 � �