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P - 40009Building Inspections 763-572-3604 763-502-4977 FAX DATE j�'} � pC, � --T- SITE ADDRESS _ THIS APPLICANT IS PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOURSTATE LICENSE, BOND AND CERTIFICATE OF [NSURANCE PERMIT TYPE PLUMBING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE I-I-2011 YOUR E-MAIL ADDRESS ` �� � � � �DWNER OCONTRACTOR Permit No.: Recei Date Rec'd: . ADDRESS: /�.T'tt� 8,� rv� S"tt'. �IJ.� . CITY_�-`—�1Q1-�I' STA' PHONE: ?C� � -,$"Y/�7 - .���j �j STATE LICENSE # STATE BOND # _ ADDRESS: PHONE �SINGLE FAMILY TYPE OF WORK: I�E�' DETAILED DESCRIPTION OF WORK I/t��r/i>na�h� _ c%-,,,� �s��,w, ❑ TWO FAMiLY R ❑ REPLACEMENT EXP DATE EXP DATE CITY FAX ❑ TOWNHOUSE , d.4�ur � Y ✓�r�.,L" I � /eS�nlT �--� l . ATE ZIP ar FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $ .50. ; i BRTH SINK/LAN ,�FLOOR DRAfNS SHOWER WATER PIPING BATHTUB _ GAS PI.P[NG (NEED CITY LIC) SWfIv1MING POOL WATER SOFTNER ($35) _ CLO'fHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($IS) _ DISHWASHER � LAUNDRY TRAY WATER HEATER ($35) FOR [RRIGATION • � _ WATER METER OTHER THfS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED T hereby apply for a plumbing permit an knowledge that the information above is compiete and accurate; that the work will be in conformance with the ordinances and codes o he �ity of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permi rk is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of o hi uires review and approval of plans SIGNATURE OF APPLfCAN PRINT NAME��jIJj$����j¢j�%? DATE � APPROVAL INSPECTnRS . ATIIR . n � _ .._._ _ , City of Fridley uilding Inspections Department 6431 University Avenue NE, Fridley, MN 55432 ?63-572-3604 FAX: 763-502-4977 ��� � � � � . . � � . , , .� e � . . . . �. . ' . . ' ; . ; . , . . . � . � � � . � .,.. V , � ' � , o� �y.t (,�.lY��- Y�° � ' .._ . . � � ��k ; i 8a ' , ; , � , � �i , .__. . . . , __ i J _' __ ` � � ,_ ..�,, ; � ; 9v� � '� ,�, r��� ; . t� �� �,�° � x � � _ �. . N � ' � �� , , , . � � �: . � I _ flY�+� � � �. _. ! � _ _ ' ♦ 0 ' �,�i�' � , � ; ' ,. , '. , ,�����►r�� ; ^ , � ��'. � .� _ : ; c� ~r� , � !+� �; � , �% ' ! � �t� ' �, �R����'�'� � . r ! '' � �u�� ' � � � � . � I _ , &�I � � �(" ��t'" : � . . , ; �,+K ' �C � � ; � �� -°-$ � , ' �� ,v�'�� ' ; ���i� � { � �1 /N, a i � IT I ' � � . VEt� � i � I� � , ' ���� I � ' � G;qb'It� Cr7yu .�� �µ �'G'M���/ I � , � � ���a ; , , , „ T � � ' o W � ;�14�!( , � , ' � � ""`� `'. �� � �� � 1,� � �`f� ' � _ ; �I��,.q � :/ ' ►2- � �.y�-; � ; � �r�� ' � y � � �� , : , � � ,� "�' ; � � p��! �f�� ; r � R ; �, � � _ . �rl� , _ � �..11'--;.----� , � � � ��� , � � ,� :_. ��' �'�n�2 � ���5 , � i 5. _ _ p�� , � __.__ � . e � _ _,. _ � -: �- __ ' ; � ��,�,� _ � � � � _ _ � � � � . � . � � _ _ _ _ � , , , , , . , . , � _ ; . ; __ , � �_ . . . � . � - ��� � � •, � � ' ' p/k�► �.v , , , _, � _ ; , �/cr�� , �..'� _ ' ; ,; � ju� �� � , ; � ; __ ; �7v�� �/,,�,� �" _ _ _ .. ___ , � � N'` i. �i , _ _� _ . . _. I _ . � _ ._ � � � � ) 1 , . .. .... ..... � .' ,. . ... . . .... ... . . ... .. � � �,: ' �,. � . ',, , . ' :' . � ,,' ��, ���. . . . I , ' i . . . � �,. � .. i. . I � . i � .. . I. ,. � , . ' �'i. : .i . .. . �,, , :' . I, ; � �,. r i , . '. , � • �