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�nspections
7�3-572-3b04
763-502,497'7 FAX
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STTE �17DRPSS _
Tlif S A PPLiCANT !S;
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From: 6127246656
Page: 2/2 Date: 11l15/2010 4:41:21 PM
M�CI�A►NZCAL —
�iESID�1rTT�AL AP�"�I�,A�.TZON
c�T� a� �nr��x
f ..� i� Y
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�] OWNCR �V. 7'ItACTOR
NAME: �j� cr �v
At�dAESS, �,�,
�r�ranr�� Gr �e� � r` �: .�
NOT�.:
SEPARA7'E CITY
L[CFNSES ARE
Rr�urnEa FoR ans
I�N17 HVAC.
SUBMI'� COPY pp HONA
PERMIT T'Xk�
CaMPANY NqME:_
CONiACT PIxtSON:
(LADDRFSS ��
L
Permit No.: �� `�� �
Received B ��
�; ,
�C�{QV �1_ �010
�._ -��.�
sTnr� �ac�s� a_�''r�.3.�' �..xF nn�
ADDRF,�CS; �: "'"p S %I4d MiI�' �7Ty ,� STAT�✓ ZIP�
Fr��onrs �_.�"('rHGp_ �nx c.a� - — y�
FAMfI.Y C1 TWO �AMLLY l7 TOWNWQU9E
TYP� OF W4RK• � � �W "�K�'L���M�T � ALTERATTON/R6MODEL
DET�,ILED ��SCRrr�TION OF WoRK
PER MS .16�.665 che permit fee is a m9ni�nrn o#'$15.00 or 5�0 o�'the tqtm� cost up to $SOQ,pIl, whichever is grcate�, for the
improvemen� ingtall�tion c�r repiaeernent oF a residentia! Fixtuire, excluc3ing che fixh�res. {This shoufd �efleet only the eosk of labor )
Labor cast pnder $300 -$15.00. 1..�►Fx,r cost �,ctween $30(} to $Spp �st oF laiycrr
�.._,� x A5 = �
FQR PROJF.CI'$ WI�ER� (,Ag()R ,F,XCEEpS $5p0, FE�S ARE RASBD pN $►0,00 Ppt FIXT1Ja�, EXCEpP yyy�RE NpTED, FiXTURES; (fNDICATE 7't7fAL
NUMBEI2 QF EACIi BELOR/)
�uipm�ent Inata�led MFG: ���iy MOUEL: � �7p�
M�(3: — �_ MOAFL: �",,, SiZCB'1'L1�
A�FC: Sf7PJ6T'U _
r...A�C 925.(l0 MpDF,L; .��� SIZFJHTU �
FfREP1.AC'E (GAS) $15.0f1 _GAS RANGElOVEN�10.00
_,Aj,I�TO AfR p{CFiANG�ER �15 �FIREp1,AGg (Wp()41$35.0� ,,,NEW Gq5 ORILL $ I OAU
.�'"" OILQi �35.00 .�'VRNACE�3S.OQ
_.._C�in2rrsv tar� ��n.00 —cAS urrrr r�'R �ro,ao
GAS DRYfisR $iO.Qb .,,_,PppT. H6ATER �,35.00
_J3ULT WORK $]A,00 ^,GAS PIPING $l0�00 v�,mn •�....� e� �.,..
�..�...�.�
Perrnit Fee $ �,
Surcharge � •50
TdTA l. DUE $ __ ���
MIN�MUM $15.50
IYumbez� of fixtures Q$10.00 �_. x$l0.Ot1= $,,,_„�
Number of �xtures c� $15.OU x �I5.00 � $
OR Number of �xtures @ $25.00 � x $25.00 = $`_„�
Numk,e�r �' fixturec C� $35.00 x $35.00 = $ -�'�
Stdt� SUTC�18rge ^ $ �� .�
MMINNIM'UM $1S.5Q Total � 9i � , �
THIS I5 AN APPLiCAT10N �OR A PFsRM1T.Wf)'I' yAt„�p [JN'['�L pRpC�ySEA
T hcreby apply Por a mcch�nleal permft and i acknowicdgc �l�Qt thc inforrnaGon abavo is eomplatv and acour�te; that thn work wilt bc ln eonfartnance wit e oriBnanps
and codey of'thc �ry o�f Fridley d with the Mtnnesota Co r' CocJpqthat 1 understand khis Is not a permit by� only an appiicadon for a permlt and amrk ia not m
stnrt without a permit; thnt thc w wi11 bc in �eeardai �p)an in tho cane c�t pU work whleh ra uires rcview and a
9 pprovst nf pi0ns. �
SIONATUItE QF A,P' I j FRINT Nr�M�,,�Gt9��.l�sr/ AT.
�0.PPItOV$I7 $Y
, DA7'F
C�it,y of �'ridley
Baildi�g Inspcctians Depart�ent
t5431 Universicy �1,venuc N�, Fridley^MN 55432