AF - 47652.
,
Date �
Owner
Address
� . � —,....
BUILDING PERMIT
Village of Fridley, Minn.
! .a���-�... .....................
.`.Lt�.�.�'.Q.f?k'�. . �: �'�. .��'? :+. C�i,l1/�'C.� .
IG9Y0 •w? ..1.... . .... ....... .....
N° 2�4y
Builder... .. ........... ......................
i�
Address.........................................
LOCATION F BUILDWG
No. ..��.l.� .. . Street . /�'` .. .. . . . . . . .. .. .. . Part of Lot . .... .. . . . ... . .. .
. . ��. � ......
Lot . . . �. . . . . . . . . . Block . 2' . . . . . . . ... . . . . Ad 'on or Sub-Division � . . . . . � . . �. . . . . , ,
� j��
Corner Lot ......... Inside Lot ....��..... Setback .......... Side ard . .... .
... .. y ........... .... .....
DES�CR[PTION OF BUlLDING
To be Used as:
(^� - � ^�
�?.Q,�! 1��. . . . Front .��? . . Depth QL.�. . . EIeight .. .�.�.
�,�P�.�:��s.. . th .��, Front . . . . . . . . Depth . . . . . . . . Height . . . . . . . . .
Sq. Ft. .1�.�!`.V. Cu. Ft. ........
Sq. Ft. ... .. .. . Cu. Ft. ..... .. .
Type of Construction .�(.r1�.-:^^.� . Est Cost . . . � � � . �� o . . . . . . . To be Completed . . : SQ.�.� .. . . . .
In consideration af the i�suance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
brdinances of the village of Fridley.
,
.
Iri consideration of the payment of a fee of $. '�J. .K�`� permit is hereby granted to . . . . . . . . . . . . . . . : . . . . . .
��.... to construct the building or addition as described above. This permit i5 granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesot� regarding location, construction, aitera ' maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at y tim upon violation of any of the provisions of said
ordinances.
.
�.... ... .. . . . ........ Building Inspector
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these items.
97-81�—l�7.6051.
d
1r 1 1 1 W � n a arr.r. � - -
. APPLICATtON FOR PUIMBING AND GAS FI7TING PERMIT
' b � � . � u watcr
� • � ~ � 'p',• w °' Hontcr
.^ a u �r� �' C M F..� � � � ,Gu ,.Ci 0.c a a � a�
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o % u D � G� v�i 3�� x w �� K 3 � � t� o as � Lnc
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; � xae . I st r
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< ch ' �
(R) � Flituxa Connaction Opaning Connected with Sawor _
(•� • flev Fizwre, Old OQening Watnr
�PARTIAL RATE SCHEDULE �
PLU�iBIl�G �IXTURE RATES: N�. RATE
h1L.5nr Fixturas � �� x 53.�0
tV:ure Fi.�cturs Openinq � •� __ X S�.00
Kcv Fixture, Old Oponing ,__ x SZ.00
Catoh Baein� w+ x S5.00
� Watar Neater - to 99,000 BnJ, �__„_ x SS.00
� 100;000 Bzt! to 199,000 BTt1 !_ x 310.00
NaCar Sottnner • �� x S7.Q0
kev Grour.d iain Old Building �,_ x 55.00
Electria WaCer Hnater � _� x SS.00
GAS FITTI�G FEES: �,� ,
,
ist ] lixtusas
1.3ditional lixtur�s
:Gai Ranga to 199,000 BTU
REPAIRS b ALTERATIONS
Pirst 5100.00
�ach �.dd. S100.00 or iraotioo
TOTAL
S_,,,_
S,_,.._
S __,,,
S _,_
S r,
5 ^�,
$ .�_.
S_�
$ ,__..
__ x 53.00 S �_
�� x 51.00 S ��,,,
__ x 510.00 S �_
• �
Staee Surcharqe
sarr►r. ��s
. q�t��gocr�nt�N Fva
a
ss. oo ��'�—
$1. 00 �c'� $ �_„
w� $ . SO
. v�y� ; � 8 00
,: ._._.
n
Job Address � 62'ZO �Fupi�Q'^ ve NE -
,� Department o! Suiidings �
" City ot Fridley �
Tal. N571-3450
The underaigned heraby make� application lor.a permlt tor tha vork het
apecilied agreeing�Co do all work in strict accordance with the City Coc
nnd rulings o! the Departmont o! 8uildinga, and hareby declaza� that a17
the lacts and repraeenteition� atated in thi� application are true nr.d cc
Fsidiey, M.�. 6-3�77 , 19_
pwrtER DENNIS L. ALEXANDER. '
KIND OF 9UILDING FRAI'RE �
USED AS RES '
TO BE COF�LETED A80UT •C�-ZO-77 �� �
ESTItMTEO COST lO.00
OLD - NEW StlILDING PERMZT N0. NQ• �
, ; ..
, �� �.��V�� '1�...
Com�
� SCO
. Signed By � -
' Tel. No.
ROUGfi INSP.
� Dute ,
FxNIRL INSP. � ' �� "�
Dato
I►PPROVl1L FOR P�lWIT i'�-.� . � •
MINIMUM FES �'OR 71NY PLl1M8INC PEAMIT t9 s7. SO
,
u
sue�ecr PERMI
City of Fridley 19124
AT THE TOP OF THE TWIN$ g U I L D I N G P E R M I T
t
; � RECEIPT NO.
� `L _____ COMMUNITY OEVEIOPMENT DIV. y
r � � PROTECTIVE INSPECTION SEC. � r9S0
1 . �
, � /"'1 � CITY HALL FRtDLEY 55432 NUMBER REV. DATE PAGE OF APPqOVEO BY
�'""� � �'� 612-571-3450 910-F15 8/19/87 / /
JOB ADDRESS 6270 Jupiter Street N.E.
1 LEGAL �pT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 6 2 � ZVan �lI�S #3 SHEET
2 PROPERTY OWNER MAII ADDRESS ZIP PHONE
Dennis Alexander same 574-9849
3 CONTRACTOR MAIL ADdRESS Z�P PHONE UCENSE NO.
N rm�ndale Services Isanti MN 444-6118
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE �ICENSE NO.
5 ENGINEEH MAtL ADDRESS ZIP PHONE IICENSE NO.
6 USE OF BUILDING
Resid tial
7 CLASS OF WORK
O NEW O ADDlTION � AL7ERATION ❑ REPAIR ❑ MOVE O REMOVE
8 �ESCRIBE WORK
Reroaf and Sidin
9 CHANGE QF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED FOR EIECTNICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THlS PERMIT BECOMES NULL AND VOtD IF WORK OR CONSTRUC710N ZONING SO. FT. CU. FT.
AUTHORIZED IS NO7 COMMENCED WI7HIN 60 DAYS, OR IF CONSTRUC710N
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 720 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. bWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINEb THIS APPLICATION STA�LS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS 7YPE OF WORK WIL� BE COMPUED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT yS�i SOQ eQO �Z.ZS
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS F ANY OTHER STATE OR CAL LAW REGULATING CON-
STRUCTION THE PERFORM Of ONSTRUCTION/. ySSQ.SO
� <, PLAN CHECK FEE TOTAL FEE
$52.75
1GNATUREOFCONTRA TOROIiAUT O. 2EDAGENT IDATEI . HEN PRO E Y LID T D THIS IS VOUR PERMIT
y :. .
� �i
SiGNATURE OF OWNER iiF OWNER BUILOER� fDATEI BIDG �NSP � �pTE —
NEW [ ]
ADDN. [ )
ALTER. [ ]
Construction Address: �
Legal Description: �"o
Owner Name & Add ess: ��
Contractor• �
Address:
LIVING AREA:
GARAGE AREA:
DECR AREA:
OTHER:
City of Fridley
� R-1 AND R-2�
Building Permit Application
i� ��.�, �«
L��6 c. �C :�
� \� � � �
� � �
n� _
s ,• ���,
Effective 4/1/86
1�.,11s �
Attach to this applieation, a Certificate of Survey of tYte
lot, with the proposed construction drawn on it to scale.
bESCRIPTION OF IMPROYEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Tel. # %
Tel. # y , 6l l �
Sq. Ft.
SQ. Ft.
Sq. Ft.
Corner Lot j] Inaide Lot L � Ft. Yd. Setback Side Yard Setback
e �'
Type af Construction: ����� q Estimated Co :���_�
� a "/00� . 4�
Approx. Completion Date: �'�.U�
�L:
Alt . n ySn�,l u�
Proposed Driveway Width If New Opening Is Desired: $ � �
See Back Page for Explanation
C
DATE: � APPLICANT: / Tel. # j r `� l� �
CITY IISE ONLY
Permit Fee $ �rc� Fee Schedule on Reverse Side
Plan Cheek $ �"'�'� �— 25� of Building Permit Fee
Staie Surcharge $ 2��'% $.50/$1,000 Valuation
SAC Charge $ $ 525 Per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
TOTN.
STIPULATIONS:
� ^ ,l Agreement Necessary [ ] Not Necessary [ ]
$ � 1
:�v"�
� p� �aa- 3 ,�
3�t�
��
.�.-
SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �
� �
� • COMMUNITY DEVELOPMENT DtV.
� �y___•__',
r � � PROTECTIVE INSPECTION SEC.
� �
� � �"'t % ClTY HALL FRIDLEY 55432 NUMBER pEv
�'""'� � ,�� 612-571-3450 910-F15
10B ADDRESS 62'�O Jupiter RD
1 LEGAI �OT NO. BIOCK TRACT OR ADDITION
DESCR. C Z ��.V3ri H111.S #3
2 PROPERTY OWNER MAII ADDRESS
STEV�N J& M COURTNEY RATHKE SAME
3 CONTFiACTOR MAIL ADDRESS
5AME
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MA�L ADDRESS
6 USE OF BUILDING
�ESTDENTTAL
7 C F
DATE
7/9/93
ZIP
ZIP
PAGE Of
� �
PHONE
PHONE
PMONE
P IT NO.
21964
R NO.
�(�
APPROVED BV
SEE AT7ACHED
SHEET
LICENSE NO.
LICENSE NO.
LICENSE NO.
LASS O WORK
O NEW � ADDITION ❑ ALTERATION O FiEPA1R O MOVE O REMOVE
8 DESCRIBE WOHK
ADDING DECK (.23� x 12�� Z�DDITIQN TO REAR OF STRUCTURE
9 CHANGE OF USE FROM 70
STIPUlATIONS
�EE STTPULAT�ONS QN �'LANS
1�1�R��HG �
Before digging caif for
ail utility locations
454�0002
REQUIREa �Y LAW
TYPE Of CONS7. OCGUPA
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OFi CONSTRUCTION ZONING SO. FT.
AUTHORIZE� IS NOT COMMENCED WITHIN 60 OAYS, OR IF CONSTRUCTlON
OR WORK IS SUSPENDEO OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AF7ER WORK IS COMMENCED. NO. DWLG. UNITS
I FiEHEBY CERTIFY THAT I HAVE NEAD AND EXAMINED THIS APPLICATION STAILS
ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WOAK WILL BE COMPLIEO 3 dQO.OQ
WITH WHETHER SPECIFIED HEREIN OR NOT. TNE GFANTING Of A PERMIT �
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING coN- 54 . QO
STRUCTION Oii THE PERFOfiMANCE OF CONSTRUC710N.
OFCONTRACTOR
nceNr ar
� �
�
iDATE�
aOUP OCCUPANCYLOAO
CU. FT.
DfFSTpEET PARKIN6
IGARAGES
SUFTAX
STATE SC 1.5Q
SAC CMARGE
FIRE SC 3.00
TpTALfEE
58.5Q
D THIS IS YOUR PERMIT
fJ�.TE �i
NEW
ADDN
��
��
il
[l
Construcfiion Addres
I,ega1 Description:
CITY OF FRIDI�EY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 5/26/93
�.
., •
Owner Name 8c Address: S-� Ev ���� m. e o ��-r ��� I+��-r�-� t« Tel. A� s7 r-�-4 �
, �'
Comractor; MN LICENSE #
Address: Tel. #
Atxach to this application, a Certificate of Survey af the
lot, with the propased ccxestructi� drawu on it to scate.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. F�.
GARAGE AREA: Length Width Heiglrt Sq. Ft.
DECK AREA: L.eng#h a 3' Widtfi ia' HgtiGrcwnd �' Sq. Ft. 37L�
� -i�
Corner Lot i I Inside Lot � �t. Yd Setback Side Y�rd Setbacks -
Type of Construction: �'► Q�.��, ��c.�TE-� �� � Estimated CASt: �,3���i✓c �
Approx. Com�pletion Date: �,.,`, ��. s ��L
(Cast an Back}
Driveway Gbrb Cut Vtti� N�: Ft. + 6 Ft = Ft x$ = S
DATE: ���93 APPLICANT: � Tel. # �7i-�9-5�8
S'iTY IISF .QL�IL-Y_
Permit Fee
Fire Surcharge
5'tate Surcharge
SAC Charge
License Snrcharge
Driveway Escrvw
Erosion Control
Park Fee
Sewer Main Charge
T4TAL
$ S.¢, w
$ � =
$ /� 5�
�
$ "_"
$
$
$
�
S� �°
r
$ '
Fee Sch�dule c�n Reverse Side
.001 of Permit Vatuativn (l.! 1Qth 9� )
$.501$i,000 Valuation
�750 per SAC Unit
�5.00 (Stat,e Licenscd Residential Contracto�s)
Alt. "A" or Alt. "B" Above
Conservatian Plan Review $454.00
Fee Determiaed by Engineeriug
Agreement Neces.sary I l Not Necessary []
STIPULATIONS:
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Design Works (SM), Knox Lumber, #220 Coon Rapids
4/10/93 15:16
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This Plan Must
Be IMai�ttsined Md
w Accessi�le On The
COnStruCtiOn SitC
�„tiP corvy� . wcI►stE'� u�►.,,�
StCIRL iN AN APPt0YE0 MA!��
�ld�2Vf ALL REFU.SE ��
�PRO�'F.D SUBJEC4 TO CO�1ro1�ifAl1(;E
70 AT]PLICABI.� COD 1ND Il'fII�CE� .
%-�t
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BUILDI�iG I1 �P CTGr�
CI?Y O�' F:RIDL Z� �:I111f�SOT�
�
NOTE: Unless otherwise noted, all joists are 16" on center
Design Works {SM), Knox Lumber, #220 Coon Rapids
4/10I93 15:16
The materials in this deck will cost �1216.40
This Price does not include any Special Order Items.
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. •
:1TY OF FRfDL�Y INSPECTfON DIViSiON
i431 vniversity Ave NE
=ridley. MN 55432 APPLICATION FOR P01NER PUINTS AND HEATING, COOLING, VEAIiILATlOt�1�
763) 572-35Q4 REFRIGERATION AND AIR CONDi'C10N1NG SYSTEMS AND DEVlCES
.���1"�`.l�ll .�
tesidential
Fumace Shelf and Duct Work, Burner -
Also Replacement Furnace
(SideVent • �ill Cut Back)
Gas Piping {Needed wi*h �ew furnace,
but not replacerr►ent)
Gas Range
�as Dryer
�Ai� Conditioning - Atl Sizes
All OiherslRepairs & Alterations (1,iST ON BACK)
1% of Vaiue of Apptiance or Work
:omrnerciat/Industr�al
1.25% of Value of Applianc� ar Work
Rate
$ 30.0�
� 1(?.()Q
$ 10.00
$ i 0.00
$ 25.00
State Surcharge
TOTAI. FEE
' � : ' . .. � _ ��� a •
.; •� . ; •►!►l •, . _ _:i!! ��
._ � ; .�
:£INSPECTION FEE $47.00/Hr
Air Conctitioners can not be Alaced in a side yarrf without
�ritten permission from adjoining property owner.
J08 ADdRESS �����
Eifective On January 1, 20fl0
/ l'�/ �C=.
:�' - , �! !�L`.
. ,
OtNPI ER ��/�-� � _
TOTAI • /% � � ��.� �
� BUILO[fYG USED AS /�-- _
ES7�MATEQ COST, 3 � �1� •� _ ?ERM1T N0._____��U��
$ �
�_._._
$
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$_�
$_
$_ .50
$������
DESCRIPT�ON OF FURNACE AND OR BURNER
No_ of Neating l�n�ts_1�._.,. Circie One (Steam) (Hoi Water� lt+��E� 1t� �m Air)
irade Name_��%? Size No._
.�.� ___� _____--- .
BTU i�C1LZ'�— NP EDR__. _�____
Fuel _._�!__,_�._ 7ota! Connecte� Load _.v_�_ .^
Burner irade Name_ _. Size iVo. ___._.
B't'i1 __ �._. �p -- ---- ERR __
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Th� undersigned hereby ;nakes application'or a permit ior the work hereirs
specified agreeing to do alf wor}c in strict accordance wFth the Ciiy Cades an
rulings of the 6uilding Division, and hereby deciares that atE the far.ts and
representatior�s stated in this application are true and correct. ��
DA.TE ----_.
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COMMON VENT.1/�NT CONNECTOR AND COM�USTfON AIR VERIFlCATION
When re lacin an existin fru_ rancse, the undersigneci hereby ver�fces that the
venting has been examined and is free from rus� deterioration, obstrudions.
and is securefy supported and firestopped where taquired. Yes (�No ()
1"he venting system is piasticlPVC and rneets a�1 current codes and manufacturer
specifkations inc3uding sizing, ietegth, number of eli�ows and termination. Yes (�No ()
7he undersigned atso verifies t�,at the replacemer�t unit is a listed assembty
and meets the current c�des �r�d manufaeiurer's specifications: This does
inctude AGA-GAMA Categay 1 CenVal Fumace Venting Tables fo� fan
aasisted and naturat draft appiiances.
The existi ombustion air is sized and installect to meet the current c.�des
and manufadurePs specifications.
When reyuired to instdtt a new combustion ai�,�it wiil be s'szed and instalted
To meet the current codes and manufactures's specifications.
Yes (�No ( )
Yes (�No ( )
Yes (�No ( )
When installinq a new ventinc� system, iFte uridersigned hereby verifies ti►at
it is a listed assembty and meets the current codes and manufacturers
specificatiorts. This daes indude AGA-GAMA Category ( Central Fumace
Vertting Tables for fan assisted and naturat draft appl'iances. Yes (�f No {)
ts iha common veni and vent connedors sized artd installed corredly after
an appiiance has beerr removecf from the ;.�mmon vent and vented
sepa�ately as per cur�ent codes. Yes (�No ()
Anntiance Type and Size/Comaeon Vent aod Yent Connector Ir�formation
Appliance #1 Type BTU Input`�� , l � Fan Assisted or Nat
AppEiance #2 Type . STU Input �an Asslsted or Nat �,
Apptiance #3'fype BTU Input Fan Ass'isted or Nat
Total Appiiances ,� Total 8tu Input
Common Vent Type
Vec�t Helght Diamete,r � inches
Appliance �1 Vent Connector Height fi Length t� piam�ter in Type
Appliance #2 Vent Connector N�ight f# Length €t Diameter in Type _
Appl�ance �l3 Vent Connector Height it l.ength ��.,�Bia�eeter in Type
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.sgection�s
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CITY OF FRIALEY
�enmit No.: '-✓ v�.� r �-
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�ESYDENT� ,A►►�'�I•YCA.'�IUl� R�vea By:
Date i�ec'd: � J
C�"Y (1� FR��EY
YOUR E MA,It. AA�1�S
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T�NAN'� CITY STA7'� Z11'
p.�bR�s'
PHO�: /'
SUBMIT A CO� OF
'OVR. STAT£ Ti.�C�1SS
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$TAT£ L1CF�t5E �� � � DATE
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�R FOR1V�'W OPfiMN(�S-D�� � OF
�PiNINC� q�At� �_- - ---- - . ..,..
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V
�ermit Fe�
Plam �eviow
Sutchar�
Fire Swrchazge
License Su�c�'ge
SAC C�ar�e
Cusb Cud Escrow
Farosia�a Gontnol
Park Ft�e
Sruver Maim C�ge
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0 HOUSE Bc GAILAG�
❑ ATTAC��D C►ARAGE
D DE'K'AG�.� GARAGE
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.e.y �n`QC�]��i���T�
2. � flcor pioo
3. List of �+ro�ra1 a�msbers �o be vacd
FORNEW CONS"k�tUGTION �i.UDa1G D�,
m
O Trim 2. Sitc P�Y � thc a� �
❑ Fascia aod PraP°s°d p�a�".
S. iiw sets oEoObse�ua�,o� P�
3• ��
L,OCATidi3 OF wII�IDOwS
VALIIA�UN, II�iC�UA�iG i'� COS'�' OF
(USING 'I'�'s 1997 U.B.0 FF.� SC���Ei
.,v � �'7n�, o O OCCUpANC'
����_ - 2 Stx Sack Page for �'ce Schedv�e
� 65% vf Bnilding Per�oni�t �me
$ (.000� ti�es the total job vahiation _�um $•Sd
$ ,�x x Permit Valus�on (l/la'�o)
S 5•C�t7 $5.09 (S� Liceased Reside,ntial Co��)
$ $1450 ger SAC Unit iPlans to MWCC for de�.ermi�on)
� R+68��ft�$20=$
� $454 Cvnservatian Plaua R,,�view
$ �ae Dete�med bS' Engi�'eeriag
�'�"� Ageement n�cessar�' () Non NecessarY (� Atta+
c _l Make checks Pa3'ab�e tto• Cit�► of �'�idkY
��
THLS TS AN APPL,ICA7�0� FOR A PERMif NOT VALID tTN'i'n F'�� that ti�e work WiA be iID
i hcrabY �P�Y for a buildinng p�tmit aad � a�ckaowledge t�,at the infornuation above is co�nplete and ac��>
conform�an�ce with ti►e o�rd4nences a�d codes of the City of �'ridley an�d with the Ma�esuta C.onsi�� C�; �t I wn�drastaad this u aot a
pen�it buc on3y a�n gpp�cation foz a permit and worY is not to sEart without a��;
that tb�e work will be in accardaneo witb tbe spprov�d
ptan in t� � of afI wo�k w�i�� ��' ��/�va1 of p�- l/ . _ _ /! , //�/ �,., �. � ,..,,. ���.��%l.�
SIGNATtJitE OF APPLICA1�Ff