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P - 42217From: unknown Page: 2/6 Date: 8/9l2010 9:39:27 AM Bui�d�z�g PLI1'MSING Permit No. n�C'� l�� �+� ��spe�tioris �j'i,�Ip�i �jTIAX, AP}'L�CATI��1' Received � : , 7b3-572-3604 � ��3�so2-4��� Fax ��TY' a� �RI�?��Y p���°� o I _ ' EFFEC71vE 7-1.�OI0 DqTE �! Q I � Q SITE AppRESS �� � I Thi1S APPLICAIVT IS: E �� L AD�.1(tESS �'H=1 J CIOWNER �CONFRACTOR � *i- r« � 'KUYL+' li I'Y NA�rIE: � Ot S�1n �Z"�Y"t� I�.'�, OWNER/ ,0.DDRESS: CA.��'�l �i-.V 11V� C[TY_ �Ptic�� STATE m�LIP.. TENAN'�' p�ONE: !R ,– � 4 �– `"t (st C1( susM�r A co�x oF. Y�UR STATE z.zc�►s�. �oNn aN�a CERTIFICATE OF INSURANC� P�RMfT TY�� nrp� aF wawc: 3TATE LICEN56 STA'iL BONB p _ rHax� �n t L— I�SINGLE F�' LY O NEW DETAILED DESCRCPTION QF WOtiK ��- ��rw�. Plumb� fi� F� 1 �' -� %"�"i1 R � � � � � _C} ri 0 V t t � N CITlt 0.� ���d � Q �U�rFnx,_,_� l�}� e-���t�— ❑ 7�+Vp FqMILY Q TQWNHQUSE t�.REPLACEMBNT �XP DATE { �" F.Xi' pA'1'E � x `Qi1 £Te ti��7 � � �£S ARE BASED pN S10.Od PER FiXiU�, E}LCEPT WHERE NO'fED. FIXTURES: pND1CAT� TOTAL NUMBER Q� E.A,CH 8�1.OW). MiN[MUM FEE E35S0. _ BA7'�! S1NKlLAV PLOpR URAINS „_ SHOWER _, WATER PIFING —�THT�� GA5 P1P1NG (NEED C['tX LIC) „� SWIMMING I�041. „� WATER 30FT1Yk�t {$35) _ CIATHES wASHER ' KI'fCHEN SiNfC WATER CLOSET ,�ACKFLOW PREV. (S15) _ rilSxwpSHER _ LauND�tY TRpY �wATER HEn7Eft iS35) FOR tRRi0nT10N ,� WATER METBR „pTy£R � �t!?�lbeP.Rff �7Cplii'eS �+�'1'�:ilQ;::;: � •Y' �L ���.'{)0•= $'..�: - - - ' , � .. ,. . • , . . , .. . � , � •T�'111hber�a�•.. . ::c:, ... .. . . . , . . .. . . . . N . ��au+e3�.�'$1�5�� �`x:�$IS:ifO. $�� . . � • - . .:�: �. _ . ... � .. . ,. � � . , . ..:.,. . . . . . ..,. � . . .:, ,: �� . . .... .. :. �. ,;: . �: l�iamber:of.�`uc�s: � S3�:b,0:� ; x �35:U0 �..:.=: �5`,. � . . � �. �,___�:,,j , , � � � �`�' . . . . � _ - .. . � . . . . . . . - �. ... :. �: ���:. .: :. ..... ... sfiai�;Surct� � �r� .�,..: � . —..::�.00 .. . . .. �°f� � . .'" . . ... . .,;.. • .:.; . .:. . . . . � � . . , • �.. • . �. • • .. : .. • „• .:•.:• '• �' ' .. . , .. . . ...:.. � .�.� � ::.;:;� .:�. ..... . . .,. ...: . . •...• : �..::� . ..•...,:. � .;. . �. .•. :. .= .. � . w••: �'•�7Yi: � • �� 1' +3�, • .n:.:�,:: - .� ..;. .. . . . .• � ....; '' ;...�'U��, '�� �j �'� ('��':'r;::...' •.: ':: '�:�Q • ��• r. . . .. . THIS IS AN APP[.1GTION FOR A i+ERM1T-N47 VALID UNTtL PRQC633ED ' I hereby apply for a plumbing �it atrd I acknowledge that the infarmation above is complete arfd accurate; that the work will be in c�nformance with the ordi�ces and codes of the City of Fridley and 'th ttxe Minnesota Constxuction Codes; that 1 untlerstand t#�is is not a pe�tnit but onQy an applic�ipn ;For a permit and woric is eot to ' w�out a penmit on site; thffi the work wiI[ be in acctirdance with the approved plara in th,e � f ai1 �At which equi ' d appr of lans. SEGNATURB OF APPLICANT ' NAM�'�� � Cr�VlR(�q� p,q� �� � I I D ednnAtier ntcer_n+n,.��..-.�.,....�.... ,_ . _ ` Ciiy af �`rid�ey Bu�Xding �ns�ections �lepartrneni 6431 University ,A,venue NE, Fridley, NNtNN S543Z 753-572-3504 FA,X: 763�502-4977