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P - 48667F�om: 61275515�4 Page: 2!3 Date: 4/25/209 2 1 1:21:56 AM FRDM : MASTER MQBILE H[1ME SERUICE PHQhJE N�. : Ea1275�1554 Apr. 23 2�12 0$:21PM P� Builcling insp�ction� 7b3-�7�-3604 7b3�5p2-4977 .FA� nn�rL �J ' srr�� nooR�ss TH1S AI'PL1�AhT 1S� TENAI�IT SUBMiT A CAPY di� �ou� srafi� i.lCENSE W1Tii APPLICATION p�F�11�YT TYPE ���������.�. ��S�DENT��1,'i., AF'FLICA'�'��?1�I CI'I'�' Cl� ��IDL�`Y , ...._....�.,.._ , , ��. � vOUR fl C�WNFR PHONE: � COMi'f4NY NAM�: • C:f1NTACT PERSON: � __ _ _.�_ S'�aT�; LICENSE p � ��p ��T� AI3C]R�SS: ��I�,�f� � ' E:iTY v►tUN:i - �?.7 ✓ r•nx ,.�..�f �SfNCrLE FAMII.I` ❑ T1W� FAMILY L7 Tflw1���Ql7SE TYPE 0�' WUIZKC d ��N' � �L'PLAG�MF.NT �3ETAlLED DESCEtIPTipN O� WORK ��,� O ALTERATEf7AflRCNIOC?CL t�'ermit Nc�,:cyUtd-����,..1. Receiv�ci �y;l� ly 1`� i� .��'���.-�--�,-�- �!..�..�..�..�. �� .��s ��.r' , _ ..,..ri'E'A1` 71I, PEES AR� B��� C>N S�li.flD FER FiXTUitE, f•XCf:P7 WFEERE NOTED. FI%TURBS: (IlvtliCATR T(19'AL NUMBF.R t�F EA�H BL4QW} P1�4Vtp£ flEhTl.OS5CA1.f:`$ �gR MANUAi.J 1006A51iHAh` HAN�Ii(?fSK. Equipnunt iostali�d MfG� � M�C1Ei; _�, ,,....,.'.,� S[LtJ13't'tJ MFGr ,,,�,�� MQDEL: �,,,�„_ Sl2ElRTlI M�C€ �' MUDEL; , 51ZFJ87't) A/C 525,00 ,,,,_,FiREPLACE {�A5) $I5.04 GAS EtANQF.if�V�N T tp•00 AfR TO AIR EXCHANG�iiti S l5 FIREPLA�`•L• (�001�?'��S,f10 N'EVJ GAS GRILL Sl`G:OD �BUIL�R 535,04 FURt�ACE S35_(ut _C�tS 11�t1T HTR $I�,Qt1 GkINlNEY LENER 51U.W GAS i�RYE3t S10.OU PCSOL. HEATER $35:00 A13�T WClRK S10.L10 �,'�E"rAS I�IPiNr„i $iQ(1(f �V�N'f'ILA'I'O:t Sf5,4U — ��... �Eumber of fixtures Q $30_#� _ x $I:U.O+D = $� hI�cttber of fixtures ce $ l S.Q4 _„_,,, x$]`5.44 �$ --- Number of f xceires Q$25.00 „� x$ZS,UO =$ Ptumber of fixtures Q$35.40 _, x 533.00 �$� Statc �urcharge ^ �� . �(MINiMUM �EE $40 00) Total � � , -�---- THi51$ AN ARPi.tCAT10N �(7R A PERiNIT-NOT VALib U1�1'flL PROCES5EC! 1 hereby ���Jy fvr 2 building pcmtit and cknowiedge t6at thc information &�bowe is comp�ete a�id accurate; that thc wark will bc in confacmancc wi�h the ardin s a d es �he City of Fridley attd wi�h th� Minaesot� �:anstruction Codes; that I�nderstand this is not a pertmit but only An ap iGat f ` t and r is �tor W start wit4+out a permit, that #ha werrk will bc in xccordsnce wFEh tE�t approved plan in the o�se a all w r c re and ap raval af piA s, � i � S1fiNA'NRE UF APPLiC•ANT ' - PKINT fd�M� �`�� �""���� DA'fE � �� _ � � i� D� � � - -:. ------ ...�.. 4 - zs — Cit� of �'ridl�y e�tlding Tn�pe�#i�ns Lllepartment 643! CJniversiiy Av�nue NE, Fridle�, M!"J 55432 7�3-�72-3544 FAX:7b3-502�977