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P - 42331From: 7635193932 Page: 3I5 Date: 4/28/2010 2:38:39 PM Buildin.g P�.LT�.1�$ING �'ermit No.: �nspections ��M�� p��X�� Received By: L� �'�3-572-36t}4 D�t� Rec'c� v ��-so2��7� �Ax +CITY OF FRI�'l�,E'X }�r�i�1 1��'l�c'z7vE 1-1-aa10 i�Cl� v /, DA7[? ""T �v� �•: l�7 YOUR �-1vt.A.a�. A,RARE5S Cl a u c. [ 4�V+�, Q Jo ,� � Y- r 5 c;��v-�. sa� ��ss t t� o �" ,�.t A u��.f � r r v� �cl f F�, r�/�T ,'�a (... '�PAN`f � cc��., u. � � SUI'TE NO. PRI�PERTY NAME: K J YY1� �`� O�'V��X2/ ADDRESS: F� c�. C7 '��' ��.�.ri� /� V� IC'�� CITY �V e c� [�.I 3?'A,7'E�FP� x� ar�r,�av�[' � � � 71 --� 7 3� PH(3TTE: ""7tn CON�R.9�CTQ� NAME: C:.P,, SUBbIIT A COPY OF 3TA�'['E LiC�iS� # C� '`^,a' [�J �� I F� I�J/i . k� AA �T� I xOt�, s�r.A,�� ' � i � 11� �c�1s�, Borrn �+1vn ��.u�az�v� �ao�v� a t a '� f,, a-�,'� � �� _ EXP DA'TE � 2 - � I �'7U c�x�zca,� o�' n�mx�ss: i� S 3� ��-rl. A v��lJ v c�x �'L. s�n,��Nzn� s's�5` 7 xNSU�tA�TCE pHf�tvF `7G 3 -� 5�' `� - �� '� �. FAx �7 � , — �L 9'. - � �' � �'�+ �t�V�.i'�' 'I'X.�E E� [�rS'�71'�'lJ'�ONA1G ��U�.�-kA�t.X ❑ swll�n►�nrrG PO4i. Q 7'QVflNHOUS� � CQMMERrCIALJINDUSTRiAL ❑ �TIiER r�� o� wa�x: ° �"�"' ;��+.c� [7 AL�RA7ION/REM4DEL / 2) D�TA,IL�A A�SCRI�'T[�IV OF WORK �r�,c5 � c�e,. �. �'I'�r¢�"f` � id c �'�'-� �,� Va. I(i- � �'- I � ��s: �nxcn� �-o-rn�. ��t ox �,.c� ,�CIATELfSWAS�R y,,.,V„FLdORDRAINS • ,Itp'ZVALYE _UItIIHAL _ B1S}iR+ASH6R ,_ GAS PiPING HACKFLOW PEtEV. _ QYATER HfiATBR ' --• DRINKIIdG F�UNTAIN _�. GRSAS& TRAP _ ROO� A��iS � w,A'�t I�.ST6R i FA.UC�T _ IUT��r Si�, ,_, SHOwER I'�WA7�k PiP�TG fLA1++Il4iAELE WASTE TANK _ LAUNDRY TRAY _ SLOP SiPiiIC _ WA�£R SOFiENIIi �, LAVATORY _ SWIbAgNG POQL _ WATER CLOSE'f Tot�� Job ��J�� All fees are bas+ed on valuatio�. iaacluding tbe cost oflabor �d materiais. Yalttstios Pe�riit Fex � `v�'p� (1.25% of Job Valuation / Mitlimtmn �e: S3� Su�harge � ,'�O valuation 7� .0005 or Minitnnm .50 '!'otal Uue � `rJ, �U Make Checks Yayable to: t�ity a��'�nidaey THIS IS AN APFLICATIQN FOR A PERMIT NOT V,A�,�A (!N"��. �ROG�Sg�A ��eby sp�ly for a�lwmbing pe�it a�ad I ack,�rnvledge that the x�t�'ormatiaa above is complete and ac�urate; tbat tbe wo� wiill be iva co��re wiit� t�ie oxdi�amces �dd cades o� t&e City o£ �xidiey �d with rhe� Minnosots ConstrucXion Codes; that X unde�rstattd �is is not a perenit but only � a�licatian for a peimit and work is not to stnrt .vi�zart a pe�it oz� site; tl�at tk�e wvark wil! be in accandance wkth #ae approved �Slan iva the case o� a11 waric wtZic�a �+equires r�vaew aad approva� of plmas. NAME DF APPLICANf �1 � f T . ,.., iM e91. h .� � S $ �'� ( ^ i� AA.� � c� � '- ! � Sl(3NA,TI.t�tE OF APPLICANI' � �'�E,A$Fs �Tp'�: S��A�iA'�'� �'�RM.EI'S A,RS �t,E U�RED F�R SL11LDiNG, LrL,ECTRiCAL AND MECHAI�CAL WOR�C City o�Fridicy Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977