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P - 48669Building. Inspectians 763-572-3t44 ���-saz�97� �;�x ���-2�} �12 TH1S APPLICANT IS: OWNER! 7'�NAl�i7' SUBMf�TA CUPY OF YoUR �TAr� LtC�NSE 1Y17'[i APPWCA'('IOiy M�ECHAI�I�CAL ���n-�r�.:.�1 '1�0-�-� RE�IDENTIAL t�PFLI�"ATT�11� ��ei�'�a �y: ��TY OF F�DLEY ' �'�� � YOUR �-MA[i. ADDRBSS � f�(q� � �i G'� � d"��. j�CONTRACTOR �IA�iE:�1'h__ "�'"� � �S ar�nxESS: (c �b l,� � c Kerr�. �'Ir �n PHONL': % C'r 3-�. ls,"'� "� I ii • COMPANY NAME: 'l CONTACTPERSQN: [�?�C'i4 c��.Sc�.y�� S7'A7'G LICENSE # �r— ' A�n�ss:12"1 Z3 - 320"�`"- r.��,c �� �HON�—T(.3 � 3&� - /d�d'r z.., � ; DA1'E 0 PERMIT TYi'E �� S�IVGLE FaNttU...Y ❑'tw0 �'AMII.Y �'rowN�USE TYP� aF v►�tTRK: ���w �( ��c�Errr o AL�nox�nbL �ETAILED D�S�RT�7'1{)N OF WQRK �LSht� � i..{�, �e'S;� c� �"°�"1t�t � FEE3 ARE BASEII ON SIQ00 PER FIXTURE, EXCEPT VYHE.RE P[OTED. 1�IXi'URES: (iNDiCAT� 'i IDTAL YilMBER flF EACK BEYOW) FROVXDE BE.�T LOSS CALC'S pER MAMIAL J 200b �RSIIRAE,�IANDBOQK. �9�P�T�nt lnstalled' MFG: Mf3DEL: _ SIZEBTU t�RiKi: ���'Q� :Hfll��l.: E1�1��C �l�s?i'i^L�.3L�* • 5€ZEBN �- �� 7t A/C 525.00 hiFG: MOQfiL� SIZ�J�3T'U ,,._A1R Td A[R £XCHAIY4`sEER $15 �F1kEPLAG� (4iA9} $15.UD GAS RAN{i�JQVEN`$t U.� _BOILF�R $35:04 _FMRBPLACE (i�IOQ�) 535.00 I�E'W GAS GRIL.[. 5i4_00 CFiIT#IVEYLINF,RSlO.UO �FC�IL'VACE$3S.Q4 GrtS UNITHTR.SIQ00 �DUCT WpRK $16.6� _GAS DRSfER $!0 00 P430L FiEA'iER 535:04 GAS PfPI�VG $10:06 VEN'flLATOR S15_Ot� iVumber offixtures � $1�.00 x'$10.a0 = $ _ Tdur�be,r Qf fixtures �$1 S.(i0 x$15 AO =$ Nurnber affixtures @ �25.{IQ � x $2S.tlD = $ 2$ • b� Number of fi�chrres (� $3S,OU x $3S.OU = $ State Sur�harge = �; 5 +i[NiM€i.rlyl t�E $4tl.uua 'r4iat ° s � THIS LS AN APPLICATfUT+( POR A PERMTT-NOT VALID UNT1L FROCESS�D t hereby apply� for a building p�rnait arEd i acknowiedge that the inforrn�ian above is �xxnptete anci accurate; th�t $�e wt�rk �yil� �e in canf�srtnanc� wi#h the ardir�ancas and cades of the City of Frid1ey ar�d with the Mineresc�ta Ccrostru�tion �odes;l6at I uriderstand this is not a e$ permit but on[y an application it wark is not to start without a permut; that tt�e work wiIt be in accordance with ttye apprc�ved plan in rhe case af wcrrk w' uir rreview and approvaJ of p1 SIGNATURE t)F APP'LI�ANT �RP+IZ' Ii e4MIE "� �� �•�+�-f � /ne Tc � ' � � '� 2- � City of Frid%y ding Insp�ctions Departm�nt G4�31 [Tc�iv�rsifiy ,Av�enue P�tE, Fridiey, MN 55432 ?63-572-36t}4 F.A�; 763-5{}2-4977 Wd 9£�LS�04 Z40Z/b�/b :a}�Q tr/4 :a��'d 88Z4 68£ E9L :uaol� 1