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P - 47339. . From: 763 444 5629 Page: 1/1 Date: 10/27/2011' 3'c50:25 PM B�uilding MFCHAN�CAL 1Permit 1vo.:�'Y c�� In!spections �+ S►�D�NT�AL A.�?'�'LTC.A►,T�O� �te�e�yed By:�.,� �s�-�72-��04 C�'�'Y C��" FRI��EY 7�3-sa2-4977 FAX __..�.__.. _ . - --- - �at���'�`�-,-�-�-- AATL'• /L�. " `°7-- SJT�s A17DRE55 Tk�1S ^PPLICANT IS: PROPER'1'i' OWN��tJ TENAN'�' coN�►c�oR SU�i�"�' �# COPY U� XQT,� STAI'E L,iG�NS£ WITH APPLICATIQN PEit�1�['I' TYF� E-MAtN. ,1�DRESS ❑ OWNE�t anv�ss: /..1,.�'0 'fs r�(�2x.�.� �uN,a:..�c�.: ,_ s�a -� .�2�9 C0IVTACT PERSt>N; sraT� t,ac�s�+�_ Pk�O�t� . 11TE`Z1T,,,� �SiN�f31.E FAMti.'Y ❑'TWO FAMI�.X C] TOWNHOUS� Tl'PE OF wORK: I C] New `�l�l�.ncEM�Nr €)ExA�.�A DESCRik'xTON OF WO.RK a Acs��wT�or����a�a�� __ F�$ ARE �ASED O�i Sib�OQ PER F1�'FUit�, PJfCEPT Wkt�At1S 1�OTED, F�XxURLSt (iND1GA7'E tOTAL NUMBER f?F �AQ# �Ri.pi�ry PROV�DE HEAT �ss CAIfi'S P��t �lANUAt ,} 2dU6 ,A,S�l.RAe HANDBpp�c. FqufDmentinstel�ed MFQ� MOt1E�,; SJZF.�9TU M�'G: 1MIOA�t.: _�...�,...., S1L�7'IJ--�.�.W.. MFG: N�QCJEL: S1i�TU A1C SZS.Ol7 _FIREPLACb fGAS) S15.W � _GAS RANGFJC►VEN 514:06 _,�.cR To � Excw►Na�sR a1s _���g�,,p,c� ���� �s,p�j NEW GAS GRILG S30.d0 HCJll..ER t35.04 FU�gIA� 535.40 �GAS UNIT HTR 510,00 ,�HINa.N�Y LINE� 510:� GAS ARXE,R 510:00 _POUL HEATER S3S,00 iNlc°rwnQrsinnt, ,.......- ---- x a�a.� � �1�i�mba of � � ��3.Q+D ,.�,._ x �].9.Ap � ��� � � �`� 6� �� � x �2�.p� � g ,.�,.�....�:� ��5� �:'(� �5.�0 ,,,..— x 53�,00 � � : , ��. , . .�b �li�D�i�p � � i1 � � �,�1 3'�.l a S �/1 _ nl�i � TNi5 iS AN APPT..lC,nT10N F(7R A P�RNN17-NOx V/u,�p j�l[, Y�p�F,SS�D �1 hereb�` apP�Y �or a buiidiuig permit and 1 ac�owledge that the inforrr�ation abova is camplcio and accurato; ti�st dlt wark wil4 bt in conformance with tht ordinsnces and ec>des of the �ity of Fridiey s�d with the Minnesota Consuuction Codes; that t understand tt�is is nat a pern�it but only an applioation far a permit and.wark is not m start wit�aout a per,mat; t�at the work wial be in aceordance wit#a the aPProved' pl�n in the case o all ork wh'ch ires review and approvai of plans. SiGNATURE OF APPLICANT � ' �'7 ��,rj� �,.� �� _ �I ^�`�P,BIMT NAME—�-'-'tiW fi� l��l1C � DATE I�% " ADWkIY'V � ♦ �wrreeew�......., ,..... . _ _.. "_ ._ . Cit� af �ridley Bu�d�ug �nspectioQS Iiep�rr�tment fr431 Univetsity Av�nue 1�T�, F'arxdlcy, �N SSd32 7G3-572-3604 FAX: 753-SQ�-4977 '�,�7.r1 ��