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P - 42330Bui�dixa;g �X,lS�7�Cti OIl�S 753-572-36U4 763-5oz�4�� a�ari 51'iE ADD�tESS T'err,n� PRaPERTY awlrr�w 'x'ENANT From: 7635193932 Page: 2/5 Date: 4/28/2010 2:38:39 PM PLU11��3�G C0�1![EI�tCI,A��, .,A�'PLICAT�Cl� CI'�''X . O�' FRIDLEX YOUR E-�+IAI4 AQ�1�,ESS PH4NE: ''1ln,�*,^'�� —�l�� SUiTL NO• Permit Na. � Rece�vec� �Y � �� , C`� v- s c: e or.�.-. �_* S C"� {}-� -- s�,�x�1�� 's � � 1 SLIBN117'A i:�,PX U� � � �Q'' X�UR S7ATE �TA'1� LiCENSE # C.) ,.�y �,�j� I p�_ EXP DAT� I r� r� I`� Lrc�vs�, soz�n ,�z*rn ��.U�B fNG BOND # �( Ca � Co �.�."'�' � � EXP DATE I � - � i �% �ia c��zc,�x� a� :�,.v�a��ss: i� 53 v a7�-r{,� ,� o�, rV v cr�x � sxa,��Nzr.� �4�f 7 [t,rstrl�,�rr,,,� ,��orrE � — 5� `� - 3 � � � � �ax�L-�_�-_c�I�t- 3`�,�2 �EYtMIT TX�� TYPE Ok' WQ�,: ❑ IlVS71TUTaO�tA.L ❑ '2'OWNiiOUSE � D�T.vi.�n n�.sc�ttra'I'.CON o� wa�x �cltr�s: (�zc�� ToTax. rK,�zc o� �sn.cr� .._c[.o�s w.ASZ�r _ AC3liVf/ASHER ,_ 17R7T�KIIVG FUUNTa#�7 _FAUCk� _ PLA1�AdA�I,� wA,3'IE TANK '�'ot�l Job Valua�ioa ,P+ez�r�i# �'� Surchmge ��[J�.�-FA,R9LY O COMM�FtC;IAIJI ��LE�.A,CF.M�.'NT �a SWIi+�nvuNG �e0oz, � p'x'��t t7 ALTEkATIOIVI�LEMOp��. �a ,_,,,, Fi.00�t A�t.A�NS _ � VALVE URINAL _ GAS P�iG 13.A,C�fAW PREV. _ WATER I�tEA'Ck� _GRfiAS&'FR,A�k ,_ ROOF AR.A�iZdS WA'k'ER MEi'ER ,�,T'�'Ck�N 3INI€ _ 5}IOWER I" 7� WA7�R AiPTNG ,,,� �..l1,U�iAxiX TRAY _ STAR' SiNK _ WATER 5��1`1�R „`Z.a#VA.'x'ORY _ SWII�@1G �c7(�L _ WAT�R C�.OSb7' S 7J, � O,Af� £�es aie based on vaEuatian, includi,�g tb,c cost of •iaboi- at�d mnatcriala S `��jS. �G'' (�.25%a�FJob Valt�ation! Minimum :fi�: S35j $ , 5!� Va[t�ation x .0005 or �uxa .SO Tota�l Aue $ �J , 5C� Make Ck�ecacs �ayable to: City of Fridley �rts �s �rr n��.ic.a�orr �ox n�a� �vrnr vn,t,m uxTU. tmacxss� I here6y apply fo�r a�iumbing permit aad � acknawtedgc Ebat the an�forma�ion ,abnve is co�u�p�ete a�d accurnte; tl�at t�e work will be i� oonfbm,suce w� �e ordinanecs and code� o� t�e City of Fnidley a�d with the Minnesota Ca�zslse.�ciion Codcs; t#�a�t � waderstar►d this is not a�t but only e� e�licati�om �a� a permit �d work is not ta stsirt wixbaut a�nit on sit�e; that the work will be iarn sccordance wit6� tt►e a�pproved plan in tbe case o:Fall wark whict� c�uiu�es rev�ew and approva.l a�'plaz�s. ��oF�� i T. L� �► �,.� c�ss��-� ��,��ta Sx��,��,z�� - °�,ix,F"!�lItNIII�'.�RE R,EQUZRET� �OR BUIi�DlZ�iG, ��,ECZTe1CAL, AP City o� k'ridley Bue��iup�g Inspections Xlepaartment 643 X U�ivexsity Av�nue �YE, F�dley, MN 55432 � 743-572-3504 k�: 763-502-4977