P - 44626Building
inspectioaas
763-572�3604
763-SU2-4977 FA.�
From: 7634283682 Page: 2!2 Date: 12/16/2010 7:39:05 AM
MECHANIC.�4L, �'G�m�t �o.
RESID�+ �TTYAL A��PLICAT�ON �eccived By:�
CIT'Y OF F�X�.7LEY �at�l�d�L� � i�
I]A'fF Y(1�1R f.'-MAIC AdDRCSS _ __ ,
srre.�nrsrc�ss �,5 1 � '(� c, ►►� -� ��' -- --
ri�is �,rr�.�c�N�r �s: o nw�vFR �scaNTRncTax
^ nnmr� v�.�� �� v.� �U� � , —
OWNER/ �ryf)RF.C51�1�, i� �*1 S'� ��. CITY 5���1ti'�� STATfi__71P -----
TENANT FMONF;�� da 4 1 q.s't� __ ___
CONTI�AC'fUR Ci1MPaNY NAMG: �—• • � •- — —
!iUf3MIT.4 C'(}NY (71' corvrac°r �'h'KSqN' � . .: — � -� _._... .. —.... ...
. .. �
Y��UR $TATR 5'I'A'1't I..ICF.,NSF. tl _,_, __ _ ___�X ��
LICENSE WfIH ADQR.$$$;_. : !TY $TATE__21P _
ANN�tcA1�oN u,. _
N'HONG -_-- F�
PE1tMiT TYP�
TXP� O(� WORit:
6�SITIGLE FAMILY C1 TWQ FAMILY
❑ NEW ,.�,EeEPLACEMENT
vET.41LED DESCRIP'l`I(?N OF WORK
o rowr�HOUSE
❑ ALTERATIONIREMODEL
�nri.t� 4 c� � �
FCES ARE BASEU ON S70.UU PER FtX'1'URE 'xC�RE N01"ED. FIXT[1�.E,S: (IhD1CA"fE TOTA1. NUMBEIt OF EACH SEU)W?
F.quiprt�enc Insrallcd MFG MpDEL:,�.S��GQ✓ SIZFJBTU ��,�
MFC: 5��, MODEL; +� G D 1J � S[ZFJi3Tl1 .�•� � v
MFG: MOC7EL:
�,A1C $25.00 _F1KEly1.AGF, (GASj $15.00
ntR TU AIR CxCt-lAKGEER �I S FIREpLAC£ (WQOD) $35.00
�BOILER 535.00 �(FUKNACF, T35.00
TCHIMNEY LINEK 31�.�� GAS DRY�R E10.d0
'_UUC'I' WOKK SIQ.(10 _GAS PiP1NG $tU.OU
1Vumber of fixtures aQ $10.00 _ x� 10.00 = S�,,,�
1�umber of fixtures aQ $15_00 x$i5A0 =�
Number of tixtures (� $25.40 ` x $25.00 = $ �� •
I�fumbcr of fi.Ktures @ $35.00 � x $33_00 = $ ��
Sffite Surcharge = $ ,S(1
�$ WV v
SI2E/BTU �_
GA$ RAhtGElOVEN T10.01�
_N6W GAS CRILL $IO,OQ
_GAS UNir HT� gin.00
PppL HEAI'GR 535,00
VEN'CILRTOR El�.�
:.�� ' '.
.. ?' �0.6,.:. . �y; ..
'� ' ,. ..
THIS IS AN APPLICAI'lON FOR A PERMIT-NO'C VALIP U1VTiL PROCESSEA
1 hereby apply fo�' a buiiding permit 2nd I acknowled�;c that the informatiat abov� 1s complete and securate; ch�t the work will I�� in
conforn�ance with the ordinanocs rnd codas of the City oi Fridley and with the Minnesota Gonstruetion Codes; ChAt t t nderstand U►is is
not a permit but only an application for a permit and work is not to start without o pern�it; thac th� wark wili be in acc�rdance witll [he
approved plan in the c,�se pf all work whieh requiras review and �pproval of plans.
SIGNATURE OF APNWCA�_ �,,,,r_PELINT NAME_ �ATE ��—;�y�==�'
NOTE: SEPARA,T:E
City o� �ridlcy
�u�(ding �nspectians laepartmen�t
6431 University Avenue NF, Fridley,lvlN 55�32
763�572-3GU4 FA�' 763-502�4977 ,;��rr,,:. ,,,y�:,:�.
,�,,,.�..�---�-��-..a._....�.-�-�-~ `