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P - 48138From: 61275�1554 Page: 2/2 Date: 12/'13/2011 12:26:25 PM FROM : MASTER M�BILE HOME SERUICE PHONE ND. : 6127551554 Dec, 11 2�i1 10;23PM Buildin� ME:CHANIC.'�L ---- _�� Pern�►it 1vo,: rnspeGt�ons RES�'��N�'IAL APPL�C�TI(�N ��'"�d ��': ' ��3-s�2-3�� ITY� 1`JF FRII�L�� '��'� � 7b3-5�2-497'� F�,X r:F�Ft`z��vi i-r:-zoi i o��,,.�..,..� � ��1 �-� �, , votr�t ��ht�� n�sur.e�:� . . . ... . - -� � .... sirr.:,�t�,�u�:ss �-�-3� �h1E?S�i' �Q.�'G�t?� . _. ..._ , _.�,_ ..... '!'HtSAF'T'LIC.ANTISE R(�WNTI2 �,j,C'UN'f'1tAC:7'4R ��:� '�'�hl'A1VT SUBMIT A CQFY OF YflUR STATE LICGNSG WI1"H .�s��r�a.r�or� NAM�� _�r,�'�:..y i.t�/.�Yfxc�[J ... . . .� a�t�t€rss: _._ . .j.._. r-�'�" ._.sTnri:_z�r ..... : . lyFi(�NE, C�AMPA1kl� hIAMF� i`3 ....:� �, .� j G �;t��r�raeTPr�so�v; i� ��t�" _ _. .. ,. ... �. --- 5'!`A9'hLICSNS t1_,_ .i�..�.a`' LXPAATB .�.... . L� ..,� .. AfJtYI��S$� �'�L � f� �� 4'�lj�� „� Ci"i'Y ' �l /�h .......—S'I'h7'��ZIP �� PIiCSNi+��1' � ��..'�S �, �''AX r � � _ .J� "�,. 1��R1VlIT TYP� �1NGL4 fiAMtLY ❑ 7Wti FAMtLY TYPE, O�' WOY2i{: �"1EY� C!'REPLACEMBNT r��r�Yr.�� n�sc�.r�r��r� o� wr�� G7 7°ow�ii�c�us� f] AL"('E1tA77UN/REM�CSBI. Yt�£, AltF �A.fiF.b fJN �10.8A t►�i� F�X�I�R�, FXl^•Ri+7' wH�R& }V07'ED, FfXTUR��: (IMDICA'1'r 'r'S)'TAL Fv�W1BER O� �ACl113�:l.�v1+) PRUViE�E ItEAT L,(N3S iC;�'S P'E� �lANUAi. J 2QOfr ASHRAE HANi?BtfCl�C. Eq�egm¢nttn�aticd MFG: ,. N1t7UEL: ,, . SiZ�/B'Ttl,_, AA9�Ci, MF{'r'r AE[t F;JCC"HANC'r�Tlt $i5' , S35.OQ' E1" LiN�ti � IU.UO Nilmiiet Of fixttireS Q$1 �.€�p � X$1 Nttrn�er of fxtures � $IS,UU ,�, x $15.0� � $ Number �f �'txtua�s (a� $25.04 �„ x �25.C►0 � $ Mt3[7fiLt Mt71�ET�s _,,_ li (UAS) 8 [5.00 e �rcac�ny �.3s.r,� 535.00 Numbe�' Of fxtures � �35,00 �,,,, x $33.00 = � �'tate Surc�rge = $ 5.00 StZEBT[J SIZ�/8"1'U eCi�k"3 RANlC}Eft31/F.'W $iQ.4Q •••�•••..— ,,,,�„NSW C�kS C�t►LL $t4:E� _GA� llNi7 fiT[� $1{i:p(t �CK�G 1�kATEii 335.E� T}{dS IS AIV APAldC.ATECIN 617R A PGEiM]'I'-Nt7f VAL#D UIUTIf, PR4I�GSS�� i he�sc6y apply for a buildin� p�rnrit and i�cknt�wledga thaf"thc infamsat�on above i� cnm�icic: and acc«rsre; thst thn wark wi!! bo its confrsnnas�e w�th the t�rdi�anoes �nd aodes of City �f�lidiey antl with the Minnq,yp� �P�tx�iCiin� Cqticfi;: khpt I uaidce�tand f19�ix is n4�t ��rmit but dnly am �pp1�i tio f rt a ' worle i� nc�t te� st�rt witttout a persxsit; th�t the w�rk wili be in ac��rdan�a w�th thc approvr.� plan in the case of 1 ie nir�es �w �nd apprtsvat af �S��n�. SLGNA'i'[1RPyt7FA(��'C.ICRN'�' r �. PRINTNAM�k'��5�� bATI�/ �tT`�''L�"'"I� / City of �ridley ��il Insp�e�ti4ns Departm�nt U' rs�ty Av�nue NB, Fridl�y, l�I*f 55432; 763-572-��i{?4 FA�; 7�+3w5(1�-A977 a