The URL can be used to link to this page

P - 42362Building PLUMBING Perrnit No.: ��+'��(�� Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY nate Re�' � 763-502-4977 FAX EFFECTIVEl-1-2010 DATE --� I 3 � U YOUR E-MAIL ADDRESS f�M W� GEL,� C7 /✓��"G . C c�Hr SITE ADDRESS �� S�� F S �"�� J�'v .� �v`, � . � THIS APPLICANT IS: � OWNER ❑CONTRACTOR PROPERTY NAME: �Itlf,llt �% K. �.�; � E�c TO NANT ADDRESS: % S 3`-� T.S�� S�: /�� : C. CITY �R� »/�y,_STATE�ti ZIR�� L PHONE: 7 (�:= .�' - 7 tl ,,'2 .� ,(�t C? � � C� �'c / L - 2 v 5 —(� z� % � CONTRACTOR NAME: SUBMIT A COPY OF YOUR STATE STATE LICENSE # EXP DATE LICENSE, BOND AND STATE BOND # EXP DATE CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PERMIT TYPE � SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: �NEw ❑ REPLACEMENT DETAILED DESCRIPTION OF WORK �-f-:Sc �tr � iU :— ��f-J �-t� ✓�=F�•-�� FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $35.50. `' �C BATH SINK/LAV FLOOR DRAINS � SHOWER 7� WATER PIPING _ BATHNB � GAS P[PING (NEED CITY LIC) SWIMMING POOL _ WATER SOFTNER ($35) CLOTHES WASHER KITCHEN SINK 53 WATER CLOSET BACKFLOW PREV, ($15) DISHWASHER `LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION WATER METER OTHER �� u �"�..,„ ,: x z� � � � � x� �, �` `� �, �..�. � `�� v&' '�' c�- � � �"'� �''��o"�� . �� ' � E � '�`� � , �`s`�' � '" �R � � �i' ��' E ��s`� � � ��:�� ,��`� � �� ` a� �, �, .� ,� � � � � �' ��; � �� t�� _ : � ^ � �' � z �� ' � � � � „� � : � y � �� "��-��t�}� � �� `� �``� �� "q�� $,y�� f �� $�'�', � �� `� �� Y'� � "�{ �'�� '��m� �C�. . 3 .�� M��' ,y�\� �, .;„ . S �'„'. � k` 1 � �, �' : 'Y � � .. �: �3 � �.x �., � / �'�' �y �5 i� � 9:' � �`� �� K �� , �� t �i�` � � �, � �� .�� k� �'� � � ��m.��.�. '� � �.: � � .� �s�� '"�' � .�,�, �t "� x�.� ��..e �* : `��r �.F � �y .� �y� g>�' �� s�` 1�� a� +�i }'` m �a��S��v'�� ,: �':. D �.�" '�"i ^� ✓ #� �+ t�"?� �� `� ; �,� � ; r�.z ^�F ! �r � z .�i��r �` �-�-��h�' � �.; � K „r �;. � � '� �rT ,w� � � `��J� ��'� `� v � �r .a. x . � � � d � . � z_ v �zr� �.w � . � �, �a� T z � � ��:�� .�� . � �i e�. �` �'� �-�g�� - ,� � �' �'� "� �� '. �, � �; � � � �a. � � r' � �, � ,y � h y � �u -�� : c�,� x�� '�`� °9 s�` �r �' � i �' � ,-k t e '�� ,�� ,��'°'� 3�3��,�� - �� .�'�r �' � s :� ,� '� �' � . � � � '� ` "° � _ � �+ �- �,'�`��v �,� �s �,�.� 3�r �� '�� ,� � c� v� z � ��. �C�';�s�.�"�� o.,��s�, � � +� `°��' ,�.,,_,�'s�� .� � � .�'� . Z �" t � . � t�'�^ � ._ fi� �� -�� "�g �,��. � � � ��'� � � � �� '�"°�� "`�"��s� � „� � � � d � � � � � � �s � �y � � � � �a� z�� : � � �=a� y��,� ��- � �� a�` �l� � '�' � � � , � �` „� ' � � �.'� � ,� � � � � ?� �",� z � .,... , , " t��e7� � .. ��.,.,.,, ...'� :� �� ..r.��i„'�',�r....r ��,< �. - ��.:z�, x :, •*�� 3 ��.� �� ,.:� � �� . ;w. � � . ��...� �r.� .��"r` �.5,��,�� ,# � U. THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTTL PROCESSED I hPreby apply for a pTumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in confotmance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand tnis 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 in the c se of a(1 work which requires review and approval of plans. -, . SIGNATURE OF APPLICA�'T�� `� :: _. . PRINT NAME .'+�,��/I Kt/F� �� '��'� �� DATE ,��--� - / 7 -� / C' �� :,, . < , a�,�, ��r,.�i� ... '.'. �, , .�.. , . -.:.',�"� . E_ �� ,��,�„�'�T ��s`�' �%:; i�.�� ° �` .. �v .. ;:a� �. .. > ��,��.�. .. �� , ai �� , s �; k% � �r„ „�'�..� �;�, .,�:%�:. City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 7b3-572-3604 FAX: 763-502-4977