P - 40000Proposed Bath Wall Cross-Section
,c�-/o�,ZS 3� 3
�uilding PLUMBING
Inspections RESIDENTIAL APPLICATION
763-572-3604 CITY OF FRIDLEY
763-502-4977 FAX EFFECTivE i-i-ZOii
Permit No.
Received By:
Date Rec'd:
DATE �� I 3� Av I I YOUR E-MAIL ADDRESS �`�,�}Y�i �C l-f C� l, i L S C�? C� M!� 1 L< CpM
siTE aDDRESS �1 GI I(o ��LQ �- N� �� � L Ly t'� r� S� �'i�- 1
THIS APPLICANT IS: f$.OWNER ❑CONTRACTOR
PROPERTY NAME: �L`'(('�YV S C i-I o� l l:S
ENANT ADDRESS: �I� /� �r'�.� S%� L CITY � 1(� L�y STATFMN ZIP S� I� I
PHONE: C�J�o�'�OcI—� I �? (o
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
CERTIFICATE OF
INSURANCE
PERMIT TYPE
TYPE OF WORK:
STATE LICENSE # EXP DATE
STATE BOND # EXP DATE
ADDRESS: CITY STATE ZIP
PHONE FAX
�1� SINGLE FAMILY
❑ NEW
�1ILED DESCRIPTION OF WORK
S 1'�.J�sYL V ALV �-1 S6�r��s c ��
❑ TWO FAMILY ❑ TOWNHOUSE
�REPLACEMENT
LY� �Ol?: L�`�C � 51 N
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
�C BATH SINK/LAV _FLOOR DRAINS LC SHOWER WATER PIPING
BATHTUB GAS PIPING (NEED CITY LIC) SWIMMING POOL WATER SOFTNER ($35)
CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15)
_ DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
_ WATER METER �,OTHEF�IU � LE.. j
_ ...�� --,-,,;;�
$�,5���,��`�` ��s�
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+��,Jr.00 - � � �
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$ 5:�
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-- ----- - THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing 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.�ridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit nd work is not to start without a permit on site; that the work will be in accordance
with the approved plan in the case a all xvork,which re� `r review and approval of plans.
SIGNATURE OF APPLICANT ��� f%'� r�E`—��� /` \ P ME %,�''�liY\J SC%hjL'i �=� DATE I�
APPROVAL INSPECTORS SIGNATURE %/I�� DATE
�� City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
„ , ' 2
�b �� V !/
- Each square = 1sq ft
- Windows not to scafe
- Utility fixtures approximate placement
ath fixtures see "Bath Detail"
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