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P - 35076
From: 7637537540 Page: 2/3 Date: 7/1212011 5:02:02 PM __ �u�ldi�g ,1V.��C�ANICAL Permit No. . Inspections ��S�DENT�.�.L ,A..�':P'LICA�'XU�T Received By: 763�57,2-3604 ���� �� F����+ � P 9�e 1����d: �.. ' 7�3-5Q2-497'7 FAX ����.._..---- . ---- pAT€_ � t u,�� SITF rll7vlt�SS �� � 'Ti-F#� APf�f,ICANT lS: PROP�RTl' N.1Mi?: C1W;v�RJ n�r�Rc TENA'VT Ol4'NER YOUR Lvi� � n�aa. � a�e� CfJAAP,.�NY NAM�:,,�► k—�'�"Y'�x�^�' $UB�1�'1' A C'�PY UF CW�'�'ACT WFdtS(J�?+1; -! j'Y"1 . YtiiJR S7'A�'� STAt� �ICE1dSC # r��C�NSr w�TFf a,nn��:ss: ��[�i� � °� c�- 53 Al�Pf,1CATt(??v PHONE'`I ''i�..>— �t, e� ��rRM�� T�t`�'E �'�firiE FAMIL.I' C17'WO FAM[LY � TYPEt?FW4)R1C: ❑y�w' �EPI,ACiiMG'NT DETAfLED DESCFtiPriON O� wpRK � v''�-- � �.. Z� � EXp [1ATE , i�� CiTY '� �'�.9��, �.ax °1 �--�7'5�-- ~�_�� �'TOWIdEJpU5G ❑ acT�:t�n�r��r�rRChtati�L n s•rA-�__!�Z�N, �F,�S ARE ��� OI� S10.dq' PF,R �IX'LU�[n F.XC:EP'f 1Y7�ERE NOTIi�Iy. �IX'X'URF5: (ItiC11GA'1'L�"I'()i'1'Ak�, tYi:D►'���',R OF �A(:H BLi.OW) PFtOV�pF, N�;4T Gt?SS CAI,C'S PER VtA\l�A , ZIf06 ,�SNf(�AE liAn�D�vVK. �q E�yuipmcnt Insc�ll�d MFC;; 1f MUpEL��p I P�O � � S12E/E3TU a�� � MfG: MOpEL: SEZE/f37'U ' MfG: „,_ MUDk�I.: _ StZ�/B7�J AfC �ZS.W �F1R�pLACG ((}A$) �13.00 _,,,`CAS ItANGE�OVfN �EU.tkl . AIRTf)A1RF,XCNAiuG�:EKSfiS ',�FIREPGAC6fW�D)S35.W �N�t1((i,r1SC�RiEd,31U.UU' `Rf)ti.fi�:R :�45 f�f1 ^„�„�U[iNACE S,i3.00 �GAS lJN1T ll'C[i S1U,(10 CtitMNF'Y I.INE�R 51q,0U 4fija511RYER SIp:00 Pqt3E, FEE.1TkR S33.Ot} rfvinr�bmnutlnna �.r...�....:��,��� . �— ....... . .. .. . THIS 1S AN �1PPLiCAT10N FUR r\ PF.RM['f-NUT VALID UNTiL PItUCGSSEv I I�crcby ap}�ly fur' a �uildirxg pC�-mi� and [ ack wledse th�t the information above is �orpptete and accuxate; th2:t the k•ork will be in Conformance with the prdi[� S ar►d codes o th CitY of �ridley attd with the Minnes�ta Cpns4ru�ti�n Codes; that [ understac,d this is nat a permit but only an applicat fox a per it nd 4vork is nos to st�ri without a perimit; t�a# the work witl be in accordar�ce with the approved ptan in tlie c�,sC vf al1 wor hieh res review at�d &pproval of pla�s. yIC�NA'I'l,'FtE UF APPLICAN f/'�,���..�� /- — �% C�I"1I \ . , PKiN'f NAM� � } tY\ ��7/tfJl JI(tn�•e � � ( �i � I 1 City� af Fridley '" u��d��g �nsp�ction�s Depa�rtrne�t 64� 1 Uni��ersitv Avenu� N�, Fridley, MN 55432 763-57z-3604 FAX:763-502-4977