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P - 48409From: TWIN CITY FIREPLACE Page: 1!1 Date: 2/21/2012 10:50:04 AM Building Inspections 7G3-57Z-3604 763-502-4�77 FAX nAr� `�- 2! {� 51'I'1�. nnUU1?SS l�Hlti AFPLlC'ANT IS; PR()PERTY OWNER/ TENA1vT CUNTRACTOIt SUHMI C A CUPY UF YOUR 5TA'fl=. LIC'ENSE WITII �PPLICAT[ON PERMIT TYPF MECHANI�AL Pennit No.:q'� ia�G:�L(7 RESIDENTIAL APPLICAT�QN �eceived 13y:���� �.'ITY QF FRIDLEY ��t� �� � , * � ' ;, � Ar R_ t..t YY . s � �f�t��,c�rov� i-i-zo�z Y'UUR l-MAIL �DllKE53 ..: �� --�--- --- . _,. , . . ... . ... .... , .. _ � UWNLR �'UN'I�ItAC:TU2 ADDRESS:_. ��r � ����JI: � C'ITY �'4�...... ,_ NAME; �L� _ __ ��±1.. ... �'!" 5'I'A I L•',�'LIP_..._.__._ �f��N�: y74�-'...�.�`t.14. ^�'`3.��a �------ _. ._ . ,..... . r --�--• ,...,. . .. ., -- c•c�navAnlv Nnnnr,..._.__._ � r,r � -- `-..:�!sr.w�.._ _. C'UNTACT PGRSON; rd5 . ....._._._. _._.....,....----......... ...�_ STATF. T.ICF.NaSF. tl __�(����' __ ___ F.7CP T7AT'F _ � �l f 3 , _. _ ADf]RP.S.� L 1��0�!'_`��!.4�^_�._�..._��... .. ... .CITY,-�---�nC1�+4T�fr� S'I'n'i'I.i�`.II'�� I'IIUNE ta/� a�'��T C'AX ���..—_��..� . . .. ..,.. �INGL� FAM[LY ❑ 1'WU FAMILY ❑ 'i'(SWNHUUSG TYPE UF WO�iK: � NLW /�RL'FLACGML'NT D�1'AI1.FD DESCR[PTION OF W�RK ❑ ALTtiRATIUNlRLMUbCL FEE6 ANE 8A5E:�� UN S�U.UO 1'F.k F�XTUkF, FX(:FI'T WHGKa NUTF.i). FIXT(1itF5: (�N���C:ATE TOTAL NUMBER OF EACH BELUW� PRUVIUF: FlfA7' 1,()$S (:AI,�'C PF.R MANUAI. 200 S RnF. HAND@OC)4C. F.q��ipmcnt h��;talled Ml�fi: �w� MUDGL: �� __ SIZ[/HTU ���� M t� G: M UE)GL � SIZEi BTU MFG: Mf7b6L: A/C $25.Dp FIRF.PI_ACE (GASI S I 5.00 AIR TO A[R L'XCHANG�LR 5!5 F1RlFLACi (WUUD) 53S.UU BOILER 535.DU I�UkNACI: $39.U0 CHIMNEY L1NL'Ei3lU.QQ CUA5 UkY�k �IQ.UO _DLIC"I' WURK S1U.UU _�GAS I'IRENCi $IU.UU Num6er of fixtures Q�! p,p0 _ x� 1 Q.00 =; � Numbcr of fixt�re5 a� $ I 5.00 _ X$15.U0 �$ Numbar of fixturce a� $25.Q0 _ x$25A0 �$� Number af fixtures Q 535.00 _ x$�S.pO =� State Surchargc = $ S.OG SILh:���'!'lI CiAti IZANGH!('}VkN �10.1)0 NEW (iA5 (iR[LL SIU.00 CiAS UNIT HTR $] U.IK) _Pqp� HLA7�R $35.UU VEN�1'ILA7"(7R 5�5.W (MINIMUM FEE S40A0) Total � S �-�' Ci� 7�E115 IJ AN A1'}'L1CA'1'IL1N FpR A f'EItM1T.N11T VAf.IT) tlNT71. PRl�CESSIiU [ hereby apply for a building permit and I acicnowledgc that the infurmatian above is caimplece a��d accurate; tttat Ihe wol'k wiil be in Confprmance with thc urdinanccs and codes uf thr Cily uf Frid3ey and with the Miiinesota Constructiun C:udes; tliat i understand this is nut a permit but unly an applicalion fur a permil and wurk is not to start withuut a permir that thc work will be in �ecordance with the arprnvcd plan in thc ca�c �f al�ork w� requires review and�provpl o pl�n�. SiGNA7URL' UF APPLI(;AN" '' PitINT N M}��,I�ti �� �)ATF. LL ��' . . ,....-- APMKUVALfNSPFC,Tp . ..i�NATURE � �� ��'�� ��� �� nATL � ' � PLEASE NOTE: SEPARATE PEItM 7S A4� RE [IIREd FQR BLIILDING. F.[.F?C"1`S2TC.AL ANQ MEC IC WORI� � City of �'ridley Building Inspections Department 6431 Universiry Avenue NE, Fridtey, MN 55432 7G3-572-3604 �AX: 763�502-4977