P - 84329�
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�uilding
Ins�eciions
763-572-3604
763-502-4977 FAX
DATE 1 V L 1� 1�
SITE ADDRESS �
THIS APPLICANT IS:
PF2.0�$'E1�2�'I'
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SUBMIT A COPY OF
YOURSTATE
LICENSE, BOND AND
CERTIF'ICATE OF
INSURANCE
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F.FFECT1lB 7-1-2010 _
YOUR E-MAII. ADDRESS
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� OWNER �ON7RACTOR
Pennii No.E
Received B
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STATE LICENSE #.
STATE BO'ND #
PHONE
P��IT T`b'PE I1"�""GLE FAMII.Y
TI'PE OF �%VdRK: � ❑ r�',�
DETAILED DESCRIPTION OF WORK
❑ TWO FAMII.Y
�LEPLACEMENT
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FAX �
❑ TOWNHOUSE
EXP DATE � Z-t Z--
r}� DATE ,��`��Z
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FEES ARE BASED ON $] 0.00 PER FIXT'tJRE, E7:CEPT WHEP.E NOTED. FIXTURES: (INDICATE TOTAL NiTMBEF OF EACH BELOV�. MINIIvILTM FEE
$35.50. WATER PIPING
BATH SII1K/I.AV _FLOOR DRAINS _ SHOWER - WATER SOFTNER (�35)
- g,q�'(Jg GAS P]PING (NEED CITY LIC) _ Si�'IMIvIING POOL -gACI:FLOW PREV. ($1�)
CLOTT�S WASHER KITCHEN SINIC WATER CLOSET -
DISHWASHER LAUNDRY TRAY �WATER HEATER (�35) FOR IlZRIGATION
- - WATER METER _ OTHER
.
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(1��IItTg1�UI� ��0 00) Tofal $ �� � � ' . � _ ;; . ; . . . �:
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTII. PROCESSED
I hereby apply for a plumbing permit and I acl:nowled;e that the infoi�nation above is complete and accurate; that the work will be in
conformance ���ith the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but oniy an application f and work is n t to start without a perrnit on site; that the work ��ill be in accordance
with the approved plan in the cas o all or � ich e w and pro of plans. VO DATE (U" 2-Ll_�—�� Z--
SIGNATUP.E OF APPLfCANT ��uT � �
APPFOVAL INSPECTORS SIGNATURE �
�.:-, „T ,- : �r �.Tn�ra: o�� � �'n -r�. �� T rlT 17R FTi'F(1R R �DING. ELECTRICAI� AND MECHAI�IC?.I� WORIt+:'`:::': �:
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1 University Avenue NE, Fridley, I��t 55432
763-572-3 604
FAX: 763-502-4977
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