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P - 48305,„w �� ,�,,,�`� From: 763 425 7461 Page: 2/2 Date: 2/6/201 2 1 1:26:03 AM ..u�i����...�iv��� �.... .�v � �..� p.�� Building p�jJ�lj$j�j� PermitNo.: �, �nspections RE�ID�NTIAL A1'PLICATIUI� R�:1�� �y:�l ��3-���-�60� CITY t)F �RIDI,EY ��� 7b3-502-4977 FA� �--� EFF�C'C6VE i-I 2012 DATE Si1TE ttDDREfiS � TfitS APPLiCA1�J'i IS< aVf�11TER/ 'E'EN:ANT SUBMIT A C43PY OFF Yt)LJR ST.AT� LIC,�fvSE, Bt31�iD AND CERTIFF�A1"E OF L�TSURAhtCE PERM�T TYF�, ❑ QW�IER SFA7E LCCENSE PF[0[VE �SINCiLE FAMIi.Y r t YOtIR E-MR[L ADI7RESS L7 TWfl FAMiE.Y � TOWMiQL}SE 0 !?AT� '�YPE ctF wt?RK: a ��w ��.nca-n�rrr DETAIZED I�ESCRIPTIO O� o� - �' ., �f,� � c . � � r�. �- F�ES AFtE BASE:13 �N � tO.pU PF':R Ff3C'TIJR�, �3tC�A9' tY�iERE NOTm. FCXTIJItES: ([I�i]3CA'£E TC1TbL W[ll�+lSER {)F EhQ�I BEIAW}. ?w(It41114UM FEH $35.50. � BATH SfNICIE.AV �Fi.CidR DRA(NS SHC)�c?YFR �i/ATER PfP21+t(3 _ BfITNTUB � EiA$ PtP1NC, (1VEED CC't"Y' LIC) S1ViMM(E+�4 P�OK3L � lYA7Elt SOFCNER (S35) _ GLCYFHES W.A.SHER _ KTfCHEN SI�1K —' V�'ATER CLUSCT _�E3ACi�FLC?W P'lt�V. ($13) � D1SH WI�3ff�R _ LAi.lNf 3RY TRAY �WATER iiEA'TER f S35} PC'�t TkkIGATI€)N � tiYATER METFsR OTHER Nvmbcr �f fixtvres (ir� $10.4� x �� U.Qi} = � 1�#�n� af £�xttu�es �,,}a $15.Q0 x $i 5.00 = $ Alcunbe� o#' fn�+es (e� $35.4p x �35.OU = $ State Sunchargt � 5.� ._ — '�HiS iS RN`APPLICATtON FOR A PERMiT-NOT vALiD I!M'IL P'l�.00ESSED E hereby apgty fc�r a pf�:rt�bi�g permit t sekr�wiedge that tlae iaformat;ian above is compl�e and accura�e; tha� t� wnrlc, wi[l be in conformanae with the o�inances and co of the C'try of Fridley and with the Minnesota Constructi�n Cvdes, that ! under��d this is not a permit bvt aoly an appleratian fos a ' w ' no to �E�art withflut a p�it on site; thaE the work �n'tl i�e u� accorda�e wik�i the app�ov�cd glan in the c�a�l wark ' re nev and appr�al of�,,,�lans.� �' tr1�, �.r,�. f S1GNA7iJRTs flF APPY.iCAMf _-- C�+�c.�' • ntT � a�us� tr J'^� "]. �I f 17 '� �/ City of Fridi�y �'�il+ding Inspec#ions Depar#meot 6431 I.T�niversity Avenue NE, Fridley, A'[i�T 5543� 7b3-572-3�04 FA�: 763=50�-4977