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P - 44992Buildin� Insp�ctions 'i63-572-3604 763-SOZ-49'i7 �,AX i?A,T� /d:• : - 517'E ADDRFSS � THiS APPLICANT IS: l?VY�I�R/ TENANT su��u�r A ca�Y a� YovR s�A� LICENS� WTTH APPLTCAT10�1 �L�Z1Mli'1� TX�� TYPE OF WdRK: From: 763 444 5629 Page: 2/5 Date: 12/2/2010 11:52:55 AM M�+ C�ANICA� Permit rvo. R,�S�DEN'T'TAi.a ,A��'P�ICA.'�'�ON R�C " �„� ,A +�° Dat��I`c +CT'�'X` OF FR�D►�,� � XOUR E-MA1L ADDRFSS CIOW1`IER �OW'1'RAC70R � . . . na�d�ess; � �l � �/�,/�Cn�rt � c»' ___ --5 PHONE: COMPANY NAM�S: _._ CQNTACT Pr,KSON: ��y�,,,� — — S'�AT£ L10ElVSE ���,,'��� P/�YZ EXP DATE _ I.�.;�%� . _ _ _ � � �--.� .. , _... . . . FHONH � � "'ff(�, 'iit' -'c��'�.3 FI�X %G.� � �4� —.�"S�/.s...7 � ,�SiNGLE FAMILX � 7W0 FA,�Ma�.Y CI NEW ❑ REPLACEI�NT Ci TOwN1i0USF �AL'���tATIpNlREMOA��. __ '� i)ETAILED D�SCRtPT�UN OF WORK .�,$ �� f,,( c � ,�d � . .� s _ - _ ��, '_.� �, .� 1 T�ZIP�,� FEBS A�4[E �ASLD UN 510.00 PCit R1XTt1$,E, EXCEP'Y" WH�� NOTEb. F�7K�'URES: (YNDICAT�'I'OTAL 1rUM�ER O� EACH S�R�Q� pRQV�pE HgAT LQSS GLC'B PFR MA.Nl1AL J 20d6 AS��1A8 HANDBOQK. 6quiDm�c 1�m11a! MPG: ,_� MODEI.: �_ St7..FBTU iNFG: .MUDEL: _ SIZF,lB'N �,,,,,,_,_ M�C:: MpDEL: SI%:FJBTU �q/�, fi25.pp _„FIREPLAC� (OA$) SI5.00 GAS RANGBK�VEN $10.40 AIR TO ATR �S�CCHAN�FF,R S15 �JlREPLAG"E (WQpD) 535.00 _NF:W GAS GRlLL 510.00 �BO[LER S3S.00 ,FUxt]YACE 535.00 �CrAS UNPf HTR S�p.00 CHIhiN�'Y I.iN�R SI0.00 �,,,,„GAS UR1i�R 510.00 _PUOI. N£ATER 535.00 ^bUCTWORK$10.t10 __ GAS_PiP1NCiSt0.00 VEraT�t,a►roRS15.04 X T10.0p � N�af�a�a�oS��iS.00_xS1SA0=S _. _ Nu�b� of ���5.00 � x 525.00 = S�. Nwnbaroifix�u+aa � S3S.00 x �35.00 � S ---- 5n� gu�e�e • c�urniKU� � s*.e�� ro�a =s '"1 U '� -- TkUS iS AN APk'LICA7'lON FOR A PEKMTY"•NQT VALID E1NTil, PROCFSSED ! hereby apply for a building pe+�rr�it and I acknowledgt tltat tt►e informatian above is completc ax�d accuratt; thet the wo�'k wi11 be in confarmanee with t�c ordinances ar►d codes Qf t6o City of Fridicy and with the Mi�nesota Consuvctioe Codes; that ! understand this is not a pernait but anly ax� epplication for•a ' and work is not to start wit�out a permit; that the work wil11� ia accordance with the approved plan in the case of 'y�oirk 'ch r i�es revi w d approvel o�' p�ans. SIGNATUREO�'A.k'PLICANT`��•, J - PLtI3V'CNAME �r,�.�;`1� .;. OATE ��,�•,r,�I �`"'� City of Fridley $ui�di�tg In�p�etlo�s Depse�rt�nent 6431 University ,�►venue �1E, �rtidley, Iv['N SS432 7b3-572-3604 FA,�C:763-Sa2-4977