P - 59370Building PLUMBING Permit rlo.: a C�1�-b0��"13
Inspections RESIDENTIAL APPLICATION Received By:�
�63-s�2-3604 CITY OF FRIDLEY vat��e°�ja�. PR ��i ���
763-502-4977 FAX EFFECTrvE �-t-zo�a _
DATE 04/27/2012 YOUR E-MAIL ADDRESS larleigh@hotmail.com
6740 4th St NE
SITE ADDRESS
THIS APPLICANT IS: L�J OWNER OCONTRACTOR
PROPERTY NAME: �ames A& Patricia A Larson
OWNER/ ADDRESS: 6740 4th St NE
TENANT 763-571-7850
PHONE:
CITY Fridley
CONTRACTOR NAME:
SUBMIT A COPY OF STATE LICENSE #
YOUR STATE
LICENSE, BOND AND STATE BOND #
CERTIFICATE OF ADDRESS: CITY_
INSURANCE pHONE FAX
PERMIT TYPE I� SINGLE FAMILY
TYPE OF WORK: I O NEW
O TWO FAMILY ❑ TOWNHOUSE
� REPLACEMENT
EXP DATE
EXP DATE
STATE MNZIP 55432
TATE ZIP
DETAILED DESCRIPTION OF WORK Replace existing basement shower stall and move floor drain to accomdate new sizer ex aus an
and recessed lioht aboYe.sMewer. Add insulation to o�� tPr.l�atqPOam'vJ�ih� Extend existinq bas� a room
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
BATH SINK/LAV �FLOOR DRAINS � 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 _ OTHER
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 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 on site; that the work will be in accordance
with the approved plan � e c e ork which requires review and approval of plans. 04/27/2012
SIGNATURE OF APPLICA�� � PRINT NAME James A Larson DATE
APPROVAL INSPECTOR�S AT RE DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977