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P - 48203FROM :CITY OF FRIDLEY Bui.ldin� Y115p�C�lO11S 763-572-360� 7G3�SQ2-4977 FA.X FAX N0. :7635711287 Dec. 30 2011 52:45PM P2 11!�.�C�ANICA,L R�SIT�ENTIA,L APFLICATI0117 C�TY (�� F��DLEY nATL��?OI 2 ,,, YOUR C-MAfL ADDftCSS S1TE AUDRESS ��j b?�d �le�__.. THIS Ai'PLICANT i$ f] UWNER (1NTRAC'TpR ��o�ERTY �VVNERI T�;NANT CONTR.A(;'�'UR SUBMTT A C'OPY QF YOURSTAT$ L]CENSE WITH APS�LIC��rrnN PERIV(1T TYPF 'r'XPE OR W�RK: Fermi� No.: Rcceive•d 13y: �'������-d�- ... N A MF; e- _.. ^r . . ,..,._ _....._ _ ,. _....— AnDRGS�' � .I_3Z� � C'IIY �r►d .� STATFMW'L1P_�'�j 7.y2—.._1F�v N PHt�NG; �P J � 5 ��J :. �s�..,... ,_ n �-.., _. ... . ..�.�_r �.� ��j��.� . ...._ CCIMPANY NAMC: �I.JYiI�Q e�i'j��'� � j� �rU � C� ,n�^,� . ._.,... C'QNTAC','f PSR5C7N; ► .1"�.._.,_. —...... _...,. ...._ .......,.._ �;TATE LICLNSF.. �i C7GJ� _ ,,...__�YYI_...,.. FxP DATL'• .._ ._...,. a.nnR�'.ss:�US ¢-anc�.0i_ K�I�.. ci ��v^S �d_..�? I_ s'rn�r�_I�N zrr, SSloz PH(7NF. �iSI �Z_2�-_�U�Ax......1�GJ��' Z-2-3Z GLE FAMaI.Y ❑ TWp [AM1LY � 'I'OVJTJHpUSL^ I�l�Ldl�.'/ DETAfI„�b DP.SC�tTPTION OF "WpRK ❑ ALTGFCA'1 ]UN/REMC1pEL FEES.q�tE RqSCD ON �IO.pO P�R PTX'I'i1RE, k�XCCPT WHFR�', NOTEU. FIXTUTtES: ([N�IC'ATF.. TQTAL NuMRFR OP EACH BEt.QW) PROVIUE H�AT Wb5 c.nr,C'S PER n�[n�vU 1. J 2406 ASHRA$ iIANU6()(?[i. Fquipmentlnstalled Mr��:�}�IYt�.�,,�1 n�rc�nFr..,��m -F�C�..c�'lc�� sizF�l�TU 1U�iJUv Mr•c: ,,..,. ... Mo�E�,, _ .. s�rHiaTu MFG: MOUEL: SIZE/BTU _„A/G $25.00 _ RIR�I'LACC {GAS) T�15,00 _C,.AS fZANCGlUV�EN $!(1.00 A[R TO AIR FXCI-IANGG�R $15 F PLAC� (WCIOD) 535.00 NF.W CAS G]t!Ll,. S 10.00 ,_RUILCk :�35,00 �RNAC'F 1;35,00 � GA5 UNI T' HTR F10A0 --- GHfMNLY LiN�.� � I 0.00 GAS URYER �6i o 00 ._ Pc�OL liEn'I`LR M3s,00 • __... nU�TWC�Rx�i0.00 . _�.r,ASPIPlNU�ic�.00 _VFNTILI+TCiR�6�s,o0 'I HT;� L5 AN APPLICATI(�N I'p12 A YF,R�9IT�NUT VAl�f I'7 1 INTiL F'2UCLStiF.n I I�ereby apply for a building perrnit and I acknowledge that thc inform�tion a�ove is complete and aocuratc; that the work will be in oonfornt�ncc with the ordinances and codes of Ch� City nf I+xid]cy and with Che MinneSOt�, Construction (`.oc�cs; that 1 understand this is Itot a permit but ottly an appliCatiott fo a rermil t�nd wo1'k I5 not t� st�rt wlthout a pe�r�pit; that the work will bs ii� accordance with the nrpro�'od piniti i�� Cl�:. �aac �Pull wurk w �� rcquh�es review and �sprovai of plans, ;�� �_ , SI(4NATURE(]FApPLIC'ANT���J�c• .,,_�_ PR]NTNAML•'_DGt� C�n=}==-.nATE�vL�I�OIZ �-.-��-.. . JR nAT� � City o�F�r�dle� I3uild� ��.spectians D���rlr�nenl 6431 Univezsity Avenue NC, F�•idley, MN 554:i2 763-572,3604 rAX: 7Ci3-St12-4977