P - 48101Buildang
Inspectiar�s �
763-572-3b04
7�3-502-4977 F'A�
DATE__�__�_ T r(�
S1TE ADDRE55 s+~
'1`�iiS APPLtCANT f9:
OWNE�t1
TENAN'�
From: 7635720164 Page: 1/2 Date: 5/24/2011 10:11:16 AM
1V�C�IAN'ICAL
R.ESIDENTIA.� A�"PL�CATIOI�T
��'�`Y OF F�tIL1�,EY
C'
YdUR E-MAIJ. ADDRESS
�
Perr�it No.: �G�' �'�� ��
Rec�xved By:��' ��
iaat� �tec'd:
� M Ai����
"....,.•^•"••'•.•;, coMPnN1rNAME: Jr�tcr r1�,TiNG & A.C;
SU�MIT A COPX OF GoNTACr' PBRSOH: FLp3CD Jp3yQICK �
YQTj� $TA'YE STATE L,iGEN3E ii EXP bAT�
LICENSE WITI� ,���s:7z21 dn�iversit Ave��[rv_Frid�.�v
APPLICATION � . STATE�IN ZIP, 55432
PNONE__76�3—�,�=�459 .FNt – �..� ,�
p�R11�T TYPE ��GL� FAMILX ❑ 'CWO FAMILy
TXPE OF WQ�tK; ° �w ��'�C�t+�Errr
AETAILED pESCR�'tON OF WORI�
a rorvr�r�ousE
❑ ALTBRATTpN/RfiM[)DE�
�
F'E�S ARE BA3F.� pN SI0.00 PER RLYTURE, EXCEP'I' WHER� NOTED. FI,I�'x'UR�S: (4'NpICATE'�'OTAL NU1VaBEYt OF F;ACA BEa,OW)
PRO'VID� HEAT LOSS CALC�S P�R MANCIA 2 A,SHRA,E HANDBqQK.
Eqtsipment lnstelled ��,. .
NtODEL: SIZE�BTU _��
[�BG: M�DBL: —,,,�„ SIZEIBTU
MFG: -..,.,,_�� MODEL: gI7F�•�•U ..�
MC i25.00 �FIREPGACE (GAS) S15,D0 ��� GA5 RANC��}VEN i�0.0�
`AIIt TO A�R EXCHANG6ER s15 pIRHpLACE (WOOp) ,�35.00 _„_NEW GAS GRtI.L Sl4.00
,SOIL�ER 535.00 �FURT1pCE S35.00 ^GA,S UIV[T H7� S10.00
CFIIMI�f$Y LMER SI0.00 _GAS DRY�'R 514.00 POOL HEATEl� 535.00
�t?UCTWORiCSID,00 _ OA,SPIPfNGS10.04 _VEN'TIL,ATOR�l5.00
��i�i — -
TNlS f5 AN APPLICATION FOR � PERMiT-hlpT VALIU [,R•1TIL PROCESSED
I bereby apply for a building per�nat and I ac�C�nawlcdge #hat the infar�ation above is cozxxpleto and accurate�; Chat the work wi11 be in
confortn,a,oce with the ordinettccs an des of tho Ciry of Fridley and with the Minnesota Construction Code&; that I undcrstand this is
not a permit but only an ap licatian'for er it and work is not to start withaut a permit, that the work rwi�� be in accordance with the
appraved plan in the Gase o il work w" ' cs review and approva� pf plans.i
SIGTIATU}tE QF AP��.[CANT PRINT NAME � ,� �
-- �T�
A�PROVAL 1N5PECTORS $IGN � pA� 1
�� �1� O� �'CI[���y _ �
Building ��spectio�s Departn�e�nt
6431 University Av�nue NE, Fridley, MN 55�#32
'i63-5'72-3b4� FAX: 763-502-49'�7