P - 42764�� I i—VJ—LY IJeYJ „��v,���om` BOEVAAG PLUMBINGYYV Pa�e:F2/4 � Date: 3�24/201 �2:37:15 PM
Buildin� PLUMBING ����t NQ.:�
Inspections ��+ ���ENTIAL APPLICATIdN lteceived By
7�3-572-3604 ��TY QF FRIDLEY ,�p
%�3'SQ2-4977 FAX EFFECTIVE l-I-2011 �����6V1�
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DETAIL�I7 DE5CRIPTiON OF WORK �
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FAF.S ARF, BAS�.D ON S1U.UU PL;R F1XTlJRE, F.Xi:F.PT WHER� NU'I'�D. 1'IXTURES' t[NPIC'ATE TC1TA1,, r1i1MAER OF EACN H�LUW). M1NlMUM FEE
�35.50.
BATN SMKlLAV FL(N)ii URAINS 51-EOWtiR � WATFR PIPINC
BAT1ffUB QAS PIPiNG (NRFn c:ITY LIC) 5WIMMING POOL �� wnTER SorTNER (S35f
C:LOTHF.S WASHF.R � KITCHbN SINK WATER CL4SET T BAClCE�LUW PkEV. (S!S)
_ DISFlWASHER _ LAUNDRY TRAY WA'I'GR NEATTit (S35) FDR IRRICA'I'!UN
WATER METER aryr:R
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Number af fixtures (r� S 10.00 � x$10.00 = S�_,,,
N�ber of fixtures aQ S I 5.40 � x S 1 S.Up = S
Number of fi�u�os (a� 533.00 _„ x S35.00 = S
St�te 5urcharge
s
= c tilfl. "
TVIlS iS AN APPI.ICATIt)N HOR A PEkMiT•NOi Vqf .1n UNTII. pRtiCFS56D
1 hereby apply for a plumbing pamit a�td ( acknawledge that the infonnedon above is complete and eccurate; that the worlc will be in
eonfo�nance with the ardinances and codes of t Ciry of Fridley and with the Minnesata Constn,ctien Codes; thet I underst�nd this is
not a permit but only an applie ' ' an is not to st,art w(thout a pemeit on site; that thc work wilE be in ce
with the approved plan in css re � eview and appr 1 I s. �^ �
SlGNA7'C1RP.C1F APPLiC r rx�x� N,►►�,.0.,,.�. _���� ��+1�i�� nnTF Z„
City of Fridley
Building In�pections Department
6431 University Avcnue NE, Fridley, MN SSa32
763-572-3604
FAX: 763-502-4977
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