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P - 48040�'�l11C�111� I11Sj��G��1()nS 763-572-3fiU4 ���-saz-4y�� r�x nnTF _ . .. ...., �7 � � Si'1'h;Al)f)ftF�:tiS (�� �� .rHis ni�i�.��t��A.N'r is: ...PRUP�:it'!'Y awN�:�i '17�:NAN'i' cxyN�ruAC:r'oR �i 1nMrr n c:cyi�v cyr• Y<)[.31i 5'I'A'!'1. i.,1CT:NST:, 13t)NI> ANU c�rr�T�ricn�rL c �i� lNSL.1►2.�NCF FERM.!'1' 'I'Y1`T: From: unknown Page: 1/1 Date: 6/7l2011 9:24:52 AM PLUlVIBING It�Si�E�i�'�"lAL APPLI.�ATiON CITY UF FRIDLEY r:rr•rcT�ivr, �-i-zo� i , f-��__ _ _�� ❑ ��wr�LU ��� nnnRr�,Sti. _c ��� 1 I'H(.)NH� �4;, � "' �,�.._ �..-----•�- NAMI',: � �I �..... `i '� STATFI.If.:l:NSL# /�1 S'fA'X'i7 Rf)NTS tl '�. �.. � nl)I)lUftiS: G� e"". ��7'�_i�.1�� Pi1tJN{i��; 7 �:J � srnic;i,r r�AMILY Y()111t L:-MA1L AUL112kStiti ......_._�,�.�.+rj,r:'�.'.-�?�j,r r . �—v���� � I,.�.0 t �vt..,� t I'kA(;TpTt YermitNo.:_ `�,�:�.+�(�j7,.. Iteceived i3y: o�t��'�: �-..___� 11 ,�?r.� ��'c'L�vrt��-, rt�� �, . .. . ._.._._.__._.--- _._._ _.._.---._...._.._. _ ( �! . ._.. �Z..A rrTY � ��,r. ''� J�3 `+rT�'j' j�' _..._..._.lj.....1 �...�•t. ,S"i'A � 7,IP J�' �..J ��--------_.__..__.._. . ..... ... ......_ _ .... ___._..... _ . . _.. .. rx� n.aTr: �l- � l r�Z- . . ....... . rxr ��n�rr : " •� ?.- > � r ,. '�' . �1 � .. ... "� ....(:f1Y ��r.3t..-(.., S'1'A'Cli "�U.II'�.1:7j;, . . . . ..... . : , �1 ..... I�nK �.. tf,,��.. R.t'_.`.7" 7`1. '�1 T�_.:......_._ .._�_....__.._...___..._....__.-- I-1TW()PAMIE,Y ❑'IY3WNi1()US� '1"YPR nf WOIik: � NGW �rj; I2LPLAC�MCNT .....:..,...,... _._.: .�., . ..�. ._...,,�-..-..--. DFTAIL�,ll L7�:5c_.Rlk�1.'�,(]N C1T WC)R � / �•f.� � - L l, �._ ������, �- „ �1� r��r°�.. �i��.. ��,;:���' ------._._._..___._...._...__..._......... . , � � r ���W�'—�.�.�- ` I f �,�.�� ,. ., ._�...... _ _�...,..__-.------�---- � ' . b'ksk:5A1t�L�AS�;ilf)N$ff1fN11'HiiNIX'['CTRL,CX.f.'F..P'I'WHk•:ItkN()'fHi) b'iX'Il1KI�S: (INUtCA'i'E'1'Cf"fALPIC1MOLkt]FfiACEIDCL�a'W}. MINIIvYUMi�G'IS ;�35._:�1. --. 13A'1'll S1N1{/LAV L�LlUOI< f)RA{NS SI IUWL;K WA'1'L:K k'LPWC .�ATH'ff 1R (jA5 F+IPINCi (NIi�U CI"I'Y LIC) SWIi1�1MING f'O(JI. __._ WA'I'F�.R ti()}•'I'NFiR ($.3S) C'.1,t1'I'HI�ti WAtiHIiR Kfl'(:HF:N SfN(� WA�tlili C:LC)5FSl� 13A(''IiF�I,('IW 1'K1=,V. (1eIS) i71tiHWASIIP.R _ 1.A[JNDRYI'1tAY WATr:Ridi;ATfiit($.35) rUR1lLILlGA'fIUN WATCR MLTLR c.YI;Hh.li Nuir�bc:r c�f Fxtures �),, !610.A0 _.. x �] ().UO — :� -- Nirtriber ��ftixt�.tres (c� $1S,U4 x $15.0� _ $ NtarYtber ofi tixture:; (� $35.00 _ x $35_(ff) — $ '; *�tatc Surchs�rge �; 5 ;UU il (1V�iNiMUM$4U.aoa__ r�ta�=� i-G�j��,.....,__ �._..,..w_.,.....,.. ..__._._. q '1'illS 15 �N AI'YI,iCA'YIUN l��]it A PC�M�T•NOT VAI,lD IJN'1'll, NKUC'L33LSL� ,� T„c:rehy ,appty for a piumhing perrnit and F xcknowlcd�;e thai tiie iuforn�ation ahcave: ix cnmplctu and accur�te; tlint the work witl be iti I� � cirtiluYttl�tC1CB Wlt1i thc nrc{ir�3t1CC5 �31�d Gtzdev ul�lhC C'ity of ��ridley t�nc� wii.h tl•ic Minnc;�ota C;oustn��tian C:oties; that t understan.d thi5 i5 � ! ni,C a per�nit brat c�nly �n appkication li�r a perntit �nd w�rk is not tc� 5tart wilhaui a perct�it on site; tbat. tatie w�rk will be in sccordancc ' ; �i•i.{.h t.hu si,Fiproved �ltn in tt c r r�f a� 1 wo`k w�icta r�yireg review and appm� al oF lans_ `:;1+;v,� f11RliUl� APi'LICANT x�E'•'7t..e�� , T-.���'� YEUN'I'NAMFi /��'"y'=• !�.,,�i�(j�(S L�A'1'L fn-J7�1 i f�I'i'ttU'VA.T..INSPF:C'1'UkSSIU�RF. .I>A'1'H.� i'I.F.ASE N{U"I'l.ic S1;�f�nRATE PL[i.Ml'1'S nRE RE(,)UIR.[sl) .l�Ult I.;l.l'fLf)iNG, ELEC;TRIt:AL ANl? MI'sC'I IANI(`:AE. WOTtK City of Fridle� Sniiding In:��aectians Dcp�rtment (i�31 llnivcrsity Ave��«e NE, taricllcy, MN S5�'i2 763-572-36U4 ��nx: ���-so2-a��� � a 0