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P - 48029From: 6127551!554 Page: 2/3 Date: 12l5l2011 10:25:52 AM FROM : MASTER MQBILE HOME SERVICE PHONE N0. : 6127551554 Dec. 03 2011 �8:22PM P2 �tj . \�L`� � __.��..,.�.....�...,.......�.�..,.,..w..•.�...,, ;�,,->.r.W �3uild�n� 1VTEC;HA1'�I�;AL I�as��etior�s I�;��il��l'�1TIAL AF�"LICA'i`�OI''d 7�3-572-3��4 [;I'I'i� OF F`RYi�I,EY 763-5U2-4977 FAX eFHLC�riv�; �_,_io� i nATF, � � y � •- � � .... U!L C-�AfL ADURL'SS � � � . �..� YU r�.' �–� �-Q1� 2 �,., Pcrr7rit N�.: IZI:C:L'EV4'Cl L3y'�_� {�� Ds�te R��;+�_,� � s�T� Ac�vrt . � , ._. _ . .. ... _.. ... .. _ .. . _.._.. . _ _.. �rH�s nr�r icar�•r tS; n «wN�2 �c���vrrcnr,TO�z --- -- -- �:. .. �RUP�K'1'Y Nnnna . �' _�_.��'� . �.�.� . --.. ._.. . _ .. . ..__ OWNER/ AUDKL:SS; ....f.'[TY _..... _�SIA`I'L'_'/,.lp--_-- TENAN•r —... -- --....... SUBMIT A CUAY UF YOUit S'1"ATE I.iCENSE VViTI-T APk'LffiATIt7N i'1i4NF.:._ _., CUMi�ANV NAME:�� CONTAC.'1' P�;ILSUN, _� STA i L LlC ��NS(F. # AUllKISS'�`'i:�� PHUNIs �� ��I GXr �ATF. i�nx �(p,�..` t �� �...!._!-? ���I� ��� �� �S'1'A'i��1��7„If���� , / e:� � . � � ._._ �rRM�T TY�T'. ���NIiI..F FA.MiLY O'fWQ f'AM1LY C]'1'UWN1IUl�5[i TYPE Ur� WORk: 6""'LW ��LN�-�f,'IiMF.NT � AL'I'I:f��TinN/REMt>DEL �w. . D�;TAFLE� pESCT�TPTxOtv C>r WORK _., " - _a. __ - , � I'L�13S /►RE BASED ON $18.Ii0 FER T'Lr'�t)��'.� E7►CEPT W�a1712C: �Y()TED. F1X1'tl17�=5= (CNDICA'F� TU1'AL NilM�if�R f/F f:A('H i3ELUWj PE20ViDE Ft�;AT 1:.(15S CALC^�u' PrR MANUrtL d ZpdC* AStiitAE HANUBUOk. L•yuipmeM lnstallet] M(�G': __. ..._ [NUULiL: 5l'GL'N3'fl� MPEi: --..... MOf>R[..: . , . _._.. SI7.F./fiTU .....__._ MFC: MUI.�EIa _..._.. .,..___._ Sl1fJ'ft9'1.1 h/f. $25.00 Flltl:]'LAE'i�: (t:�.aS') 515.00 c:,AS FANCiE/UVCiN S60;GQ� ,. �. A!R TUAiK t;XE:HANGEEK �15 I�tEtfPC.AC.'E{WWU) 535,O4 �NISw G�5 f�I2C1,1. $lO:OQ �641l,.Fft 535.0� FURAtAC:[: �:�5;OC) tiAS UN1T H'CIt 51U.V0 CHIMt�EY iv1T*I'FI2 $1�;00 �-�i/�S t71t.YFR S10;1H1 Yvtjl,l�rATT�:R $35.0� �dUC."T' W43RK $C�.pf) �CAS PiPINti SiU.00 _'�F.1�1TI1.RTf?R RI5.0f) Numbcr of fi�turex cQ $ I U,QO __ x$10:00 =$ Nttniber of fixtures �t� $15.OQ _ x$ I S.iIU =$ Nurnb�r af fatuz�cs c.� $25.U() _ x$25.00 =$_ N'umb�r of tixiur�s (r� $35.00 � x '.635.00 = $�,�� State Sur�h�rfie = $, _ 5.(10 (MIMMUM ��� �40.00} Tota1= $ `'� �� 'I'i 115 IS AN APPWCA'E'iUN f�fltt n I'Ft2M3T-NnT VALIL7 UN'flt. 1'it(�C k SSt?f) I 3icreti�y npply for .� Uuilciin� permii �nci I ackn�wled�e that the infnn„ritinn flhava iF com�letc atici aocuratc; thal YhC work wi11 he in Confornzance w+th the orciiiia[tces :tncl �odes of tlic City of I'riciley and with thc; N1inx�esotA C-�nsu•uetion Codc:s; that i�ndGrstanci this is nc�t a permit but only an �tpplic� ' n '��cimii �und w4rk is noE to start wi6hu�rt fl parmit; that the work will be in AGCOrdAnce w+th the appruved plan in thr e�se o al h re uire icw cantl �rFirnval of a s. . SIC.rNATi1KL•" C�I� APPi.Sf:.AN'l' _ . . .__PKIN'i' NnMM:��l� � ....., f?ATE..,��:� � City af Fridley " Buil in� I�spections D�par. tment 5431 UnivE�rsit� Aveni�� NN,'Fridley, MN 55432 7G3-�72-3fiO4 FA�: 763-502-4977