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P - 46261v� _. `�__ _,� �` ` M�,vFrom:7634988380 ` Pa�e:1/2�vvDate:6/17/201111:09:53AM N`� Build,i.t�g MEC�IAI,TICAL rennit No.- �x�spections 1tESIDE�1'TIAL APPLICA'TION R�"'� By� 7�3�s�2-�6aa �ITY OF FRIDLEY R�� 9����-�-� '�,-� 763-SQ2-4477 FAX ��,� 1-�-�� � aAr� . � -:..1 _7 - ! 1 YOUR &MAII, nnrsRRSS f' � - � ,S ��1+',�1a,.r �.�.c� h�..��� w ca�+'t SITR A[)f)RP_SS 531.�._ �i _l �c, jQ�a rQ N. -- �us n�N��c,�,rrr �s: o awrr�t �ncrcx� PI�OPERTY N�,,�: Ow1�TER! ADDRF.�$; So.r�c'. crsv ---- s'enTe zrr TENANT PHONE: �oN��to�t COMPANY NAML�:_ C?Ei U s P 1��io 1a�, c�,�rc•� Wc�►�:�r, �a �. - SIJAMfT A C.'pPY [)i� WN'fAL"!' PkstLSO1V• `7"�,wi T; e� � i�- al� � b(�,'3 C7 YOE1R S3'ATE STATE L1GF218C M„ .. _.. SXP pATE LICENSGW{'I1i ADDRSS5:;��i %Q�1r�6� bi.t1�. CPl'Y�"[�..�,(ri„... STA7'F.lh;'YhiP,��'�,� APPLICATTON p�iONE 7tn,3.. �$�- L''Stif 7 _ r�►7c ,��' �.��,.' S� 3�C� P���T .i.�,p� � SINCiLC PAMiLY O TWO FAMIf,Y ❑'1'C1wNHUUSF TYPE oF woRx: a rrFw �(Kr�ncEMenr�� o �,.:raee►7,orr�o�[. DETAILED D�?SCRIH'1'iON OF WORK ScsS�'A�I� iaJ� o� n��.3 G I4.S�,,,� ._ +1 FEES ARB �AS�I1(NY S1Y-N PRR iPlX7'El#tE, BXC�'C"YYlf�it� N�D. F�KTURB& (IIVDICATS TOR'AI.1�UM�it �F �r1['H �Ri�4Nry PROYmE HEA1' I.U6S CALC'S PER 1►+AANilAL J 299d ASHRA� HAIVDHOOIi. �1��P�tlnsWled MFG: M(7Ib3L: �^ 91ZFJBTU �►'u'�� .�__,.,.r�._. MODF7-: SIZ6/B71J Ml�iC: MODI�: Sl'1.8/B7U A/C $25.W FIREP[,ACLi (GA.�) S15.00 .,�.�_ _�— C3AS RANQT�lOYF]V s18.00 _AIR TO AiR EXCHAN(iRBR S15 TIREFLACE (WOpp) 535,00 NEW GAS (ikILL $10.00 BOlLQtS35.0U r�)�NwC� �35.00 _�GaS UNIT HTR 510,00 �ClltfV�Y LII4Qt SlO.OQ � _GAS DRYFR S10.p0 PC.7�t. H�A'{'RR x3s,pp .. u��rwot�sto.ao c�ns���cs�o.00 —v�rnr.n�cs�s.00 Nvml�r of fixturc.� (i� $10.OQ _ x S! 0.00 =$_._.. _.,_� Number uf fixtures (a � 15.M1 _ x� 15.00 �$ Numt�er of fixtures {i� �25.00 �, x�i25.U0 -� S,___.._____._ Number oftixturc:s �a� $35.00 •-- x S3S.Q0 �� State Surcharge = $ S.UO MINIl�I[JM FEE 540.00 Tota! - $ ; TiQ3 IS AN P1atGAT�c�K rOR A PERMiT-NOT YALID UN'F'tL PROGESSfiD i hercby apply fw a belldin� permit and 1 acknawted�e that !hc inform�tivn abovc is axttplete and accurate; that the wcsric wil! tx: in conformanrc ��•ith the orclinanc.�es ttnt4 codes of tl�e City of Fridley arid �vith the 11'linnesvta Constcuction C¢+eles: th�t I�m�fer�tund this is ��ot 1�ennit but nnEy an .�ppticaiinn k�r a pCnnit ancl wc�rk is i�a� t� s�M witfi�in a�ern�it; that thr wnrk wiEi t�r in ucconi7nca ti�itli the approvcd plan in the case of alt work which rcquires rcvicw and appruval of plaatis. SItiNATURF ()F APPl.ICAN'!' --•' "" ��� PR1NT NAM.F,`_ ,�',�M, � � �j, UATG � � I / ' �! .1l'1'!t�)1'.� l, t\jPF.t; Tf1RS S{f:ti.tTt �RF. [)ATE �..._ .�i_,L• ;1';b tiilrT'F: .'+EP,SR;1TG PERi1•ilTS .�itt RI?t)Ut}Ztil) FCilt.tiUil_1>Iiv(:�. �-_I,F:<"1'R1C:1L :��iD bIEC'H,1VIC.r�L WUKi� rt�. wTr • •• �.. i�� VZ •�i�ta�i�i T �� • .flllRl�tiR�i� ���jtirv\��i�i•Y �4��M���ii�\ei{l S.:^. ! " _ ' 'r• _" '�3 i .T . . ....... •£� .�vc:�iu� ivu. i'iiu�4v, ni:� 554.�� � '— � �••J�'JT ��:�ili. lVJ�JV{.�"J',Ji J