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P - 48668From: 6127551'S54 Page: 1/3 Date: 4/25/201 2 1 1.21:56 AM FROM : MASTER MOB I LE HE�'1E SERU I CE PHOF�E N0. : 6127551554 Apr. 23 2012 0� : 20PM P'1 �Ui1C�1I1� ME�HAI�IX�AL p��17"t �� Inspcctions ��S�DENTIAL APPI.,Y�A►T�C}Pr1 Rec�ive� 753-572-36q4 �Y�'i� ��' F�ID��'� oate��� 763-5fl2-4�i7 FAX • ��F�.-��u�,_,_,�,, DA'fG '"'�-nG �.7 ' SlT� Ah1iRF.SS TH1S APPLIf:AtvT`1:5: PR(7PETtT'i' 4)WNER/ TENANT G(lNTRA�'iQIt SURN117 A C;i�PY pF YOUft STA7E LiCEN5E �YITH �PPLiCA'tE�N YfSltit �'� � � ��. .�,�6 Ql)�VNFlt CONI'F�A �r1+�e��...-..�.... ADD�2F.•iS: � PHONE: ' CO�vlPANY N�ML. � CX3NTAC'i' P£RSON: �, t�.� � c'CaTEi i.IG8�dSE u ,'C ADDRESS: r�or��'ilt�� `"1�' `��i k, fXP i�A"Cli FAX _/l[J.=.?L P��MI'�"Y"Y�� �; �SiNGLE FAMfLY f CI TWQ €AMILY i7'i�WhIHdUS�; , .:: '�'YPF UF WURI�f: f] NEW �i EtCi!h.AGEMENT �� C1.�.LTERATIONlRFMO�L•L DETAILED DESCTtI�YiOt*i O� WOI�IG 5TA �EES AR£ BA�EDQIY $t0.011 AF.R F'1�(7'URE, �XGEp'r' WHEi�F.N(YCEtT. F1XTUitESt (lNDIGAT� rp'7AL NUMBER OF E��CF! $1?LU�!') PtFOV[UF HE4.T LQ$S CAI.C`S FF,R MAh1i1A�, ,! lpOb ASIiRAE NAMUBUO!{. Equip�mnt tnstalicd • ,, MFG:t,.._-.,,..,., .. FAODEt: �_� 51'LC/t#'I'lJ , ; ' � j ••• __ � MFt3s �_ MIQDEL: _ SlZ�7BTU' MFG: ` , MOAFi.;, i SE24%If37'U ,_A/c 325.00 _F'1'R�PLAGE� (GA9) a i 5.00 =. ti. _GAS RaNGFJOV�T15�0.0i! AtR TQ A�k �XC:��ANCi$iiR b15 fIRSPLACE (WOOD} 535.()0 NEW GAS ,f.r1tI4L 5iR.00 �Bt)ILER 535.�0 6CIRNACE $35:UU _„GAS UNIT HTR �3fl,U4 _C`H1MNtiY LIN£R SiU:W CAS bRY[R $�0.9Q ,.__ P()t)L HIATE�R 83S.Ofl Wi3RIC $3p.4Q 1`+�,'�iA;S PIPITVC, 510.00 �. ... a�fx�����aaa_,,.x�zc�.nc,=�s _� :. �� Nurnbcr of �xtures Q$ E 5.�0 _ x$:15.0�! = g _. ; Numbcr of fixtures Q$2S.Ui? x$25.pQ -$ ', lvumtxr vf f xtures Q $35.00 „Y,,,,,,_ x ��S.OU = $ ( ,. � + : ' s . St�te 5urchargn = , � $ �,(lQ , f {MIIYiMUNi FEE 540.00) 'Totat = $ v � 7'lil5 f$ AN APPLfCAi'i{)N FQR A PFRMIT-NOT YAl.lD UN"�Yl. PRt1K:�SSED � [ hereby a�,ply fvr a building perrnit And ' cknawledge thac the inforrnati�n aEsove is camplete and accurac�; that th� work will be in 4 .. CQnFt�rcttiarict wikh tl�e b*di � d �s •the•City'cf Ft�idley aiid w:th'�h� Minncsota ConsEruction Ccnics; that !" undersc�nd �3tis is not;s perrnit bat cnly an ap fCS t�n r is not 2o start with�sut a�qrmit; that khe work wilE' b� in accordance wish 1hG approved plan in the case o all w �� � r,h r �i a�rovsl o�p1� s. SI�iNA7URE OF APPLiCAN7 I PRlNT NAMF, � � � �Q ����,,,rt,_bA1"E ' � �� ^ 1 � t APPRQYAL IAiSPECTORSaSICNAT�IR�. _ ,� L7ATr. � —�'S ^l� '� C�t� of Frf�ley �Idi�g Inspectia�is Department i LJniversity Avenue 1VE, Fridley, MN 554�2 7G3�572-36{�4 �AX: 763-502-4977 ��� 0