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From=6127246658 Page: 2/2 Date: 2/17l2011 12:13:45 PM
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F��9 ARE i3A8�0 ON Stn.00 PER FI:�'fURE�I d 2tW6 A9ka'R,AE HN �B00lC.�IR�Se (INDiCA'�E TOTAL NUM$ER3 ZF�B ��ELO� —
PItOVTD� i�IF,AT LOS9 �ALC 5 PEA Mr1,NU MOUF,L: �—
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MFCi; ^,.�-- QAS RANCrElOVEN �10.UQ
A!C 525.00 T'iREPLAGE (CiAS? �15.A0 N�"W GAS GRtLL 510.00
AIRTG► A!R EXCIiANCtERIt �1 S FiABPLAC.� iN1��i $35,00 GAS 11NiT HTR $10.00
�BOILFR �33A�1 �p��N��� $35.OQ ��, HgqTER �35.OQ
I CHIMNEY LiNER $1Q�0 _GA3 DRYBR $t�.04 VENTIL�ITOR $15.�0
_.______.. . .. GAS P1PlNG $10,00 , ,
THiS 15 AN API�LICATION FOR A PP.RMiT-NUT VN.fD UNTiL ('ROCGSSED
I hercby apply for a buiiding pe��nit and I acknowledge that tltic infoi7nation above is camplete �nd accurafie; that the work will be in
conforrna.nGe with the ordinances a.nd codes of thc City of Fri.dley �nd witla thc Ma.nn�csot� Constri.►etion C�►dcs; tbat I underst�snd tiiis is
not a p�rmit but only ao applicatipn for a permit and work is not to sta�t witl�o�st � pen�it; th�t the work wiil bc in accordance witii the
approved plan in 1;he case o#'all �vork whien rec{uir�review and ap�.raval of plans. 1' /�
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SIGNATURB OF A1'PLICANT
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Caty ai Frwd�ey
Buildx�� �r�s�ectio�s ��part�tex�t
G431 University Avenue NE, �'rxdley, MN 55432
753-572-36Q4 k`.AX: 763-502r4977
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