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P - 48239From: 6127551554 Page: 1/1 Date: 12I23/2011 3:16:51 PM FROM : MASTER MOBILE HOME SERUICE PHONE N0. : 6127551554 Dec. 22 2�11 C�1:14AM P1 �"'�'�,.�,.,. .�,...._.�. f � � ..i 6 ('vrj � {, � k"' �� I � � - 11 � �1 F�uil . .W.�.,,,,...�, 1 i,, f� Y �- ,. � �,�� ...�......._�..,�..,.. _— 1V�E�'H.A.NICAI,� ..._ .1'err�� �it N , ���,�i _��_ � Inspections ' R 763�572-3604 I�E��DEI'VTX.AL �PPLIC�A.'��IQN �44ei�e<� sy: 7G3-502-4977 FAX C`ITY �F �+,.�;ai.�� Date Rec'�!: � �A�r,.;_ ) i �� �rre A�r�u�;ss., T4IIS APPLICANT iS; r�opErc�� OWNER/ TENANI' C4N�'RAC.T(?R s�rsMrT a �;ot�Y o� YOUR S'k'ATL <<lCENSE WITfI APPLC�ATION rr�t��c:Trve i-i-zqi 1 Y`U[1 1:-MAIl,�L7�RF.$����� ��� ��5����. �,.� 0 owNi;�t C�r�TRnCrort -- — — IVAMi;;,�"'{�t �,� � " r1 !/�JI+..F �'n --Y�-bF� nr�nKFSS:-- �-- --....— pHpN�;^ .__ C:OMPANy NAM�; � --�� c'ON'!'At;T PC� � S'I'ATF, f.�('g,�SE ir Ail13RL55:�� . �+,�� �d.>��L YI{UNR 1 �Jl �.���� _ ��i� _Ctrv ( 'S� �Nr[ P. ( c —.—... . - —,.._S`I'ATE_7ti'_.,. �— ����°� . � ;_�r�c.. .� _- �-- �, .— ..�. . rXY DATfi: _ -- _��.��j t u r. CITY �.�� '. 41'hT���]P ^�-/ � _ rnx „�-�__ � �._. ��.=-��. PF,RMTT T�'p�„"i �:SfNGC.F. F/,MILY �'I'WO FRMfLY p TO�VN![OUSH TY�� OF W�R[C; NEW O ltEP[,AC'L•'MENT � AC.TFRAT[ONlItI�Mb[lP;�, ��TAILEU DESC121�TION QF' WOni� � - - i�LE3 ARE RASED ON $f0.p0 PBR FiXT(lK�;, EXCf 1'7' WHERF.IVO'P�D. PCX'i'�1RE5: ('livl)ECATT 7'U'I'AL N�1M�ER (7�' t�;q�'q gtr,�,pW) PROVlDE HEAT L4SS CALC'$ pLR ytANUAL J ZUUG ASFX�AL; HAND�4UK, Equiprr�ent lnstal led MNfJ; Mnn�L. .. ._ ,_ S1LL'•'IBTU Ml�G: ---, ... MOt]Fi,; MFG: MODl:L: „ A!G $25.Q0 FlREPLACE (GAS) $IS.UO � _AIR Td A[R 6Xt:HANC,�LR �35 r11t�YLACL {WQOD) �;5; .OU BUILER $35.00 F[7RNAC.f; $:15,UU _CHIMNEi' LiNBR $1o.W Ga5 nRVER g10,00 _L7UCT WURK $lO.QQ CipS piPiNC'r �14,04 Nu�uber of fixtures (c� $ t 0.0U _ x$1 U.00 =$ NumUer of f xtures r�i $15.04 _ x$15.U0 =$ Number of fixtures @ $25.00 � x $25.00 = $�._. Number of fixtures (;u $35.00 _ x $35.04 = $ sizr:it��ru Sf7..RJf;'I U _GAS RANt;�/C1VL•N $!0.(7p NF.. W{;nS GRlLL .� I p,UU (;AS UNlT HTR $tq,(�p . noo�. xLA�r�a ��5.00 _VENTff.ATO1Z S 15.OD Stac� Surcharge = $ 9.00 (MYNIMUM FEE $40.00) �'ot�l � - $ �' � ' � � 'tH15 1S AN APPLIC:A7'IUN (�OK A PERMfi'-NC>'I' b'Ailll UN"CIL YEtUGL"S5LD � I lxcz•cby apply f�r a building permit and I acknowlcdgc that thc information abovc is cvm��lct.c �a�ci a.ocuratc; that thc work wil] be in conformance with thv ordint� es and eodes nf the �t of Fridley and witEz tl�e Minnesota Consu-uction Codes; diat I understan�! this is not a permit but onty t�n �� ic�tio f rmit and w is not in � xrt witl�ouf a pcnvit; t]iat thc woxk wil] be in accordance wif[� the �zpprov�d �ian in ihe case o ail w i rcqua , rcvie .ind rlp T���i orri� 5. � SItiNATURE UF ANYLIL:AN'!' ' � �(� %� � . ..... .. ,.. �.,�--- R�T'NAML . V �� y� � lX�. � llATJ'c� �........�.�... 'sPECTORS SICNA'1'UKG NOT.E: S�PAkA'C'� ] �1zM11 � A ii FOR BUILDING, E�,EC'I'RIC .L ,A.ND 1'�ECHANICAL WO �x� ot� Frrrd�e� (�,�j � f � Uf� � �t�' dx�,g nspecfiions �epartment �'�� i� ! Ei431 U�.�z ' y Avenue NE, Fridley, MN 55432 ��� �.�� �_ pb� q� _ c��g� 763-572-3G04 FAX: 763-502-4977 � 0�7� r �f ,-,�,� I ��r�o�.�,�,,n �� -�-i"�, � �►f�,� � � � � {� -� (���