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P - 84354� Build�ng �:nspectio�:s 763-572-36Q4 763-502-4977 k'�4X UAT� � l�J"L'��) �y�TB A1�6RH55 _ � 'S'N15 RPk�LIi�AN'f l5: t�V�V�� • OWNEEi! 7'�NAN'� CON'T'RACT(aR SU�MI7' A COf'Y O� YouR sxATr: LICENSE WITii APPLIf:AT10N From: 7637551554 Page: 1!2 Date: 1012212012 4:04:44 PM ��,#��A� Permit No.•` ,[.�— R.ES�DE�iT�,AI,� ,��PLIC,AT�.C3N ��`"�� sy:F�� , cY�rY o� ��u�►�E� '�C�°��-� 1'VUR �•MAIL A17nftESfi a awN�� °I�/11�"7��l�u! �'� ,� ...,r�r��rn�r±�a�t . �°ar.�:Ni►.fIlJ►f� CUMYANY N�Mi: c�t��AC; �- ve�3��, ,4 STA'1'F I.tE:�NSE k A (J�RLSS�, PHG1�li .� te ��' CXP DATE __ -- �� . `..�.^._.ClTY ' . S'PAT�ZIP_ ,_, ! FAX�(C�..L�Y ��—� �ERMMT TXPE '-DQ�NG4E FitM1I.Y O'rwo r"aMi�Y O Tc)wtutiOt�sts Tti'pE t7F W0►R1�: �N�W I� Rt^:PLACP",MGlVT Cl AI.T'F.KA'3'{UN;KtsMOUl;l, DE'�,qILED DESGRIPTa'CJN OF WOftK '�' FEES Aft� BAS�D �?n S1O.OD PF.R F1X'TURE, EXCEk*T WH�RF. NU'CED. FIXTUREB: (lWDICAT� TOTAL NU�BER �i�' �A�K Bi1,dV1� PROVI6E K�AT LOSS' CAI.C'S P�,R MA?VUAL d 31t06 ASMRAE HAN6800kC• S�Z�d.rU .�., _„_. __ Lyuipm�ntlnstatt� MFG: _. ._,,._ M0�7EL: �,�,,,.. _ nnr'C: _, Mt)D�.i.: S3ZGlH'i'U ._......._.�...... Ml%G: _ " MO1)f•,I.: ... . til/,E'li I't' A/( SZS•Ul1 _t'IRiPl.AtFi(4iA5)SI$.(10 _, Gn51tAN(i�3t)�I;Nj1U.W T Alki T4 Ailt F.XC'HANtiEfilt 515 _ 1�IRGPLAi'fi (W00�) 535.U0 TNF.W �AS Ciftn t Stu:W � y�t(,$R S�SAQ �Fl1RNAC;� S35.OU �VAS uNl'P HTM SIO.W � C'HIMN�Y UN13R Eli�.tHt iCA51)RYER b10:t10 _ P()(}I. HtA'r�R 535.n0 —�.� �r�r nrnu r c i rt nn �GAS YtpING S! 0:00 � VEN'1'iLATUR $15.00 — Nu�iber of �xtuxes Q$ tO.tW _ x$14.00 = Nwmber of �xturas Q$15.OU _ x$J 5.00 =$ l�iumber of �xtures Q $25.00 _ x $z5.00 = $ Nurraber of fxtures o(7 $35.OQ � x$35:04 = S�„�,. Statc Surcharge = $„ 5_00 (MINIMU�1. FEE �35 plus surcharge) Total = � -- TH1$ 1S AN APP�.1C'O.TIUN F�K A PCRM)T-N07 VALID VNTlL YROCf:SSE[7 t hereby a�p1y for a bui�ding permit a�d I acknowledge that thc irtformation sbove is camqlete and actu�'ate; that thc work will be i confoimancc with thE nrdinartc�s nd des of t�c City of �ridley and w�th the Minn�ast�ta �onst�uctian Codcs; t�at I underst�uad this i nvt a permit but only an ap ' et t� ermit an ork is not to start wiihout a permit; that che wark will be in accvrdance wieh th approveci plan in the case u;a11 h' uir iew and approval o I na. $I(iNA'fUKE OT APp�ICAN'I' _ ___1'Ftlh'I' NAM�� ;�,' � L.1 i �� PF._._� D �� "�� -4- .._. .. City o� �'ridley S i ��ng inspeetions Department 6431 iversity Aver�ue NE, Fridley, MN 55432 7b3-572-3604 FAX: 763-502-4977 ^� L 4 � i�� C'�.L � �� 1 � - � -� �� f� -�O r �/ ti �I� �` 1 h�n � � n1��r? ��nS��c�Fr�n � . �'�'