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P - 36965� ` �`V � y From: 7637463777 Pa�e: 2/2 Date: 1/20/2011 3:02:46 PM �VL J, � ,.`` „ 1� �` yr �y,'��a.�, � �,..,���.� � . , , , � .�.. �.,� � � � � � _ � � - �i�.ild.i�g �nspect�ons p � 76�-S7Z-3604 7�3-so2-a977 �FAx C>ATB� Sf7'� Af�DRGSS �,,,,� 'f1119 APP1.ICwNT [9: C1��VPTRR/ 7`�NAJV'1' SUBMIT A CqpY OF VOUR STA7E l�C�NSP. WI'!'kl AP�'LICAT'i0N P�RMlT TYP� i �� �7 :lV�+��IANTC,A:� ��m,�i N�.: RESIDEN'r�AY. .A..�P'�'x,xCATIQ�1T ���°�c� � � 1 C�TY O�' F�.tIDLEI. C 8 13 f�t��CTIVF. I- I-241 I 7'7'"= �"—�"� Yr^�UR �.�I�tll. ADDRESS- - _..� la OWNF�R CoNm�xv N�����C'A!. JN� -- - - CON''1'AGT P +.,.-�-•- �G4�#•'I �ard�+et�tm�itNE srar�3 �.���se � N�► �,�IL - M11�304 mc� �nrr� wou�ss: crr,r s�r���� z�r, PHQN� - p� PAM14Y I�'1'Wp PAMfLY ti'YP� OF WQR1C: � � Nr�ww �x�'xi.,�ceM�r psrni�,�a a�.s�x�oN a� woxx G]'fOWNHOU3E O ALTLRATION/RF.,MQL1�1. �i�S AR6 8A.9ED pN S10.0Q PBR FlXT�11tR, ICXCBPT WHN.R� NOTgD. p�XTtIRLSr : i1N1lICATR TQT�►I, NUA�fa�R dP �A�A O�I,,QWj PROVIDL+ 11�A7' 1.(a58 CAI��'6 P�R MANWA-I,��R TIANDH0�1 MC►DE1.: I„�'�1 �'D � 917.F./BTIJ «�--�� CquipmontlneWled MFO: � � MFQ' , M4DP.1.: 8l�13/9TU�� MF�: �•� F!RliPI.ACI"s(GAS)TIS..00 �D�•: ____"—"— GASRANUP.�:7V6NSt0'�i0. -�� 'fta A1R F37CCFIANf`g� SI S _Ft.RGPI,AC6 (wQQp) �S.,pp N�W dAS �RII.L SI0.00 ^AUILi'sR S�5-oo _,,,FURNAC� S9S.On �GAS IJNl7 FffTt S!0•OQ CHIMNL�Y 41NF3R i10.00 _GAS DRYqItSID-pp ,,,_PC101, Ii�ATBR S3S,00 �„�p��T.`�5�.�'�� -- —DASPIP1NqSIQ,00 �VEN"1'11LATOfISIS.00 .,_,,, , X � lO,Op � Numf� oE fixwres (� �] 5.00 �„� S15A0 �+ S Numbar qf fixtura Q) S75,OQ � x;C2.5,00 �� �I.� Numtior oFfu►�s (r� �35,00 � S.0 , Stata Surchar$o � �,i ��,�...,,."'�t1,UU , „ . ._..—... . �_ TF1IS (S AN APPI,ICATt�M FOR A PQltM11`-NdT VAi.tq tIN'i'!4 PR(�$$�i�p 1 hereby npply fp� a building pem�it and 1 uclawwlodge that tira infortnation nbova is comploto and accuroW; that tho work will ba in contbrnu�noo with the ordinancxss and cncl� aFcho City oYFridlcy and with tho Mlnnaaata Canstn,ctian Codea; th�c 1 undorsmnd thfa is not � pertnit but qaly an npplication for a permit nnd work is not to �tart without � pCnnit; thnt thc wa�c wilt bo fn aCCOrd�nce widt iho appmved plan in tha case of�ll work wh�ch raqqires reviaw and approval of pians. 91GNATUR� OP �J �ity o�p�?'ridlcy _-- �uiiding xrr�peCtions �epartmcnt b431 Univr,rsity Avenue N'E, �ridl�y, MN 55432 76�-572-3604 FAX: 7b3-S02-4977 rr 4Qy�l �