P - 42369From: 9522558603 Page: 2/4 Date: 7/29/2010 3:24:44 PM
Bu��di.ng PL�[l'1V�3I.�TG
Insp�ctions �����TIAL APP�,��.ATIaN
763-572-3604 �x�� a� F�n���
763-502-4977 FA� ��cnvE7-t-2oio
81TE ADDRESS �
THIS APPLiCAN'F TS;
OWNERI
�NANT
SUBMIT A, Cp�X dF
YOCJR S�'A'x'E
LICENSE, �ON�'1 AND
CFs��FICATE OF
I1�SU�t.t#NCE
��YtMIT TYP�
Tll'P� Q�'WORK:
I��T,
L7 OWi`1E1�
NAME: �
ADri]tES.. ,S�"��
PHaNE:LOl2 l�
NAN�&: .S�'4:
sT,ar� z.zc�vs��
STATE BOND #
AADRESS:�
�k�ONE �,�
� SINGT.� FA1V,[T[.X
�
0 NEW
;ON OF WORK �
YOUR E-MAilL Ai1DRESS
�%'dIVTRAC74R
O TWO FAMILX
�REPLACEM�'N�'
FA7{
� TOWMiOUSE
Permit No.:24 C�
�teceived By����,.
� �?ATE
�7QP A,A�
k��S A,12E BASID ON $10.04 �R FIXTURE, EXC�PT WH�� �t0'�D. FIXTURFS: (nvDlCq,'x'�'�p'�',qZ, aV[1MBER pF EACH BbiOVV�. �I�1t�UM k'EE
535.50.
� A.A,`x'kI SINIUL.AV _��,OOR DRAIIVS SHOWEIt WATER �P,ING
_ BATHIVB _ GAS p1P[AVG (�T�D CITY LIC) SW�N�A�xNG POOL ' W,A,'�'BR SOFTNER ($35)
,�,� CT..O'A�S WASH�i. _ KiICI�;7d SINK WAT�R CI.pS�' BACKkJ..OW P�V. ($��
_ F�SHWASHER _ LAUND�X �'�,A,X �WA,��t �E"iATER (S35) kUxt �G,A'�ON
_ WATER �k;�ki.R _OTHER
I hereby app�y �'or a plumbin�
canformance w�ith the ordinan�
�tot ��crnzit but only an a li
with t�te app�ved plsn in c
SiGNA�t$ OF AFPLiCANT
A�exavnt, nasPEC�rn�s stG T
�3 xS AN ApPLICATI0�1 �4�t.A T-NOT VAL,1D LTN'T7x. ��iQCESS$D
�mxt and � acicnowledge tb,e xn�ormation above is co�p�ete a�d accutate; that the work wA1a $e in
arad codes af the ' � k'z�dtey and with the Mizuuesota Canstruation Codes; that � uraderstand this is
on for a ' and work as mot to siart wtthout a pe�zn�t o� sate; that the t�ork wilI be in acco�dance
����hich requires Xevaew and a�proval of pl�sns- .� . . _, _ . , ..
�`I� O� ��"It�l��'
Buildiaug �nsQe�tions Depa�rtment
643 � I,J�aveKSity Avenue �, ��ridley, MN 55432
763-572-3604
FAX- 763-502-4977