P - 42207From: unknown Page: 1/1 Date: 4l28/2011 9:39:47 AM
Engir�ee�.�.g LOA.D ��MIT
De�artment MOD�F+ �CATION ,A.PP`LICA 4
7G3-572-355 � CITY OF �'�DLEY
7f3-571,-�,2$7 f�.x EFFECTxvk111/201a
APPLI�ATIO� pA,�: `L b t Yt]UK �-MA1L ADDR�SS:—
THiS AP��,�C,ANT IS: HAULER ❑ P�OP�RTX OWNER
P�tO�ERTY OvVNER: �u� �+� C�{xt.� �k�ON�: �
JO$ ADDRF.SS: S� �-1 �1 �. � �'x, i T �LI � �+� �+,+�i•1 �`+1�i
MA'I'ER1.A.L TU BE I�AIJL�D: � y4t� P'; "�"
A'A,�S 7'0 BE HAULED (UP TO 3 DA,XS): �'Z� ���
TH1S PERMIT IS iS5U�A TO .A�LLUW AN INCR,EA,SE O� ,A,XL�
AXLE TO ��V� (5) TONS PER AXLE OVER TI�E �OI�LOW�1G
NOT�C�: �is perr�it is valid only for vehicl�s �nraut� to ca�st�uct�vz�
S:OU pm. See Reaolution #01-2004 an,d State Sta�te Section. 169.$7
�E�X'X' �U3'�' H� �i VE�IICLE WHILE HAULING UN
NUMBER OF X.OA.�S
PERMIT FEE
$25
$ �S
'CH1S lS A�i AP��.aGA'�'AOIV ,�'4�t ,A, ,P���'-N8'�' V.A,�.�A
� hereby apply for a load Waa�s �odx�cat�on, permit a�d i acknowledge that the information
wo�rk will be i�a ca�n�'or�ax�ce �►�th the ardinances and codes of the City of Fridley. I unders
applicativn �vr a �e��t af�,d b�au�ing 4� Kestf�cted ros►ds is tto4 to Stat't withaut a�ermit.
5IGNA'FIJRE OF APPLICANT "�" PRl1riT NA1VfE_
.A PP�iOV�p �Y
COPIES G1VEN TO: ❑ POLICE C� ENGMEEWNG
Gity a� k'x�dl.ey
E�ag�neeirii�ag Uep�rtment
6431 University Avenue NE, F�id�ey, �i '
763-572-355�
FAX: ?63-571-�287
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