P - 48540From: 61 2 822 5408 Page: 3/3 Date: 3!8/2012 4:21 10 PM
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Building ��,UM�r1V�G Permit No.:��l�'C� C ;�7
Insp�c�ia�s ��,�Z��NTIAL APPLICATION �eceived $ . �
��3-s�z���o4 CITY (JF FRZ��,�'Y h�"�e��a': "� `� �� �;
763-502-4977 FAX _ �F}EC.T�vF,.,-zo,z
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YOUR STATI's
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DETAILED DESCRIPTiQN OF WORI�, _'�� P�-�C� �.�%'/� j,'�.y� 't�-� _ __ _
PEES ARE BAS�D ON $10.00 P�K CTX'fUtt�; BXC�YT WHEtzF N�TED, FIXTTJRES; (IND[CATE TdTAI, NL1IvzFjEit OF EACH BELOW). MINIMUM F�
$75.50.
_ 13A�f7-1 S1NK/LA V r'I,OOR P[LrtINS gHpVJE�t WAT'GR PII'ING
_ HATI-PTIJD CrAS F'Lk'IN(i (NP.FI� ('1TY i,1C) SwIMNIING POOL w.a�rEx SOr'7'r7Et2 �.�35)
_CLOTI�ICS WASHER r� KITCHP.N SfNK WA'ILR CLOS�T RACKFLUW YREV, ($15)
,,. DISHWASHEK _ LAUNDRY TIIAY =WAT"Ek 1-IEA1'El� (S35} FOR I�tJL[GAT[ON
_ WATER METER _ UTI�I�R
I'HLS 15 AN APPLICAT�(jN FpR A PFRMIT-NpT VAT,II] U7JTIL PRpCESSED
i heteby t��ply foY A plum6ing pcmiit and I acknowledge titat the informatipn al)pve is comp]ete and accuratc; thRl th� �vork will be in
cnnFormancc wilh thc ordinances and codes of the City of k�ridle}� and tivith tl�e Minnesota Construction Codes; fhat I understand this is
not a permit but qnly an applicltion far a per "!�d W rk is not w s[nri without rt perrnit on site; that the wark wil] be in accordancc
�vith the approved plan ic�.il�-�;,rs�e af t l wor I''e r� �ires rcvicw and app�a�of plans. % JJ�,���
SI(`zNATIlItE (]F APPLIGA Rr� PI(� NT NAM� � S'I��� �fJ-r�DclL-�d1�I]ATb �� �I'(`{ ��-
APYROVALlNSYF.C:T(7RSSi(:NATiIRF. /�� nerc�'�=L�' J
City of Fridley
�uilc�Yn� Ynspections D�paY•tment
G431 University Avenue N�, Fridley, MN 55432
7b3-S72-3604
FAX: 7G3-SQ2-4977