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2008-00882Building MANUFACTURED HOME Permit No (X°Ob Inspections INSTALLATION APPLICATION Received By: ``' 763-572-3604 CITY OF FRIDLEY 763-502-4977 fax C UN EFFECTIVE 1-1-08 DATE: C� YOUR E-MAIL ADDRESS: 72 INSTALLATION ADDRESS: T THIS APPLICANT IS: 91NSTALLER NAME:—,5-.r MANUFACTURED ADDRESS: �® ��' ITY ii^-� STA — ZIP HOME OWNER PHONE: PHONE: ® " 3 0.ELL PARK NAME:�e��;�/�!�-�`� a NAME:- om: © INSTALLER/ STATE LICENSE # 2 EXP ATE: APPLICANT SUBMIT A COPY OF ADDRESS. �7 J !'t�o� �a �/ ITY STAT a ZIP S5S0 YOUR STATE LICENSE PHONE `�Gj %Sri - -Z) F2 CELL: FAX: SUBCONTRACTORS NAME. PHONE NO: GAS: ELECTRIC: PLUMBING: NOTE: INSTALLER SHALL BE HELD RESPONSIBLE FOR SUBCONTRACTORS OBTAINING THEIR PERMITS AND ARRANGING INSPECTIONS DESCRIPTION OF MANUFACTURED HOME AREA LENGTH WIDTH HEIGHT SQ Fr LIVING AREA CARPORT AREA DECK AREA ABOVE GRD: OTHER 6 E � � � �Fc�lk�4"+F�z p I C NV ATiJ R "� k , . ? 4 `^`„ „' i - v 1 f .w..a� *.A' 2 PERMIT FEE: $100.00 SURCHARGE: .50 TOTAL: $100.50 RECEIPT: STIPULATIONS: 1) SUPPORT STRUCTURE MUST COMPLY WITH THE STATE BUILDING CODE 2) MANUFACTURED SEALS TO BE DISPLAYED ON STRUCTURE THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a manufactured home installation permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance w, approved) la in the case of all k which requires review and approval of plans. r SIGNATURE "'7 �ys �el--p ��=`DATE ? OF APPLIC -� PRINT NAM / APPROVED BY DA MANE 0-90"u—M Mm City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-5024977