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P - 45809�uilding �:I�SjJEC�10I15 ��3�s�z�-3604 763-542-4977 �'.A�X ��r � f r S]TE ADDRESS �,_ T�IS AFPLICANT IS� awrr�r� �'�NANT StJBMIT A CQPY 0� XOUR STATE �.iC£NSE, BOND AND CERTIFiCA'i'� (?F iNS�J}tANGE PEyt1VlYT TYPE TYP� OF' WURK. From: unknown Page: 2/2 Date: 6/24i2011 1:39:56 PM PL�.VI�II�TG Pe�at No. RE�ID�+ N'I`�L .A.�"�Lr�t�T�t��.'�T x�cezved sy C�TY OF �'�DLEY ���� BFFECTIVE 1•i-2011 —r.----_�,1 YOUR E-1VfA[L APPRESS _�i a�'�' L++� _G.c� 0.kv�.S O t�'I�i �h'�t. a. C3 OWNER �CDNTRACT[>!L ea, GQ NP�ME: iYl t k'"�' -.. �/Y'1 d():'�, _.. ADDRESS: �� C? �(_ t�� �.3 b�, CITY � Y`� C�. ""T STATE G1"�1V2IP l�'�''��'S 2 PNON�• � (!1 � �I "f.s� � hiAME: � f�kve� S C� -- `i�i m�c, A! a w. b t �n �. W'�-�^ �t e�-er s�.ir C $'1-ATE LICENSE # �{Q �? F�I S" EXP DATE t z 1� 11 �.a � z. STAT� B�NDt # _ + �- R� 0 S (Q � � GQ �P E`X�P,, �DA7'E � � � i � Z.� ( ( ADDRESS: 5�� Y I S� htr tJi � L-t�. N CiTY b C�.:� �'+l 11 STA,T� �� �IP `�S �� PiiONE � 2.C1S- � p Ivv,.S�-er ��.x � t��--�},��...�--�oq! ,_ . � � _ , ,. _ _ _ ., _ _ -�---� _,._ �j,`SINGI.E FAMILY n NEw DET,4��ED pESCRIPT1i�N 0� WORK ❑ TWp �qMILY f�1 TOWNHOUSE �S REPLACEMENT FEES ARE SASED ON 5i0.pU P�R Ft}LTI1R&, EXC�PT WHERE NQT.2p, FIXTUFtES: {)NDICATE TOTAL NUM�ER pk� �A,Gfi HELOW}. MINIMUM F�� S35.jb. _ SATht SINK/LAV _,�,��.ppR DRAMS ,,,_ SliOWER WA7'E�t PIFING —����g CsAS PIPiNG (N�ED ClTY LIC) SWIMMING PdOL � wA,TER SdFTNER ($33) CLbTHES WASHER �ILJTCHEi�1$tNK WA'�ER CLOSET BACTC�LOW PR6V,{$1S) _ DISHWA$HER _ LAUNI7RY 7'RAY �WATER J��,pTER (535) FOit IRRfGATlON _ WATER METBR . - � _.A. : . . ..,...,..., ..,�,,,::.. .�...;.,.. �!}-. ;,••: � OTHER tY�oa,�.%�,1Iq�V�� Ni�ber of ,i3xhues,@ $1� QQ �x;$��0:04 = $=.; `. ( G ;. �L� C� .'.' .� , _ M`�"'�c _ . . . .. h � ,.,:.: -�uv.�.v��- . <<: - Nu�iber af fixiunes (u� $� S:.(�0 ` , x�$15 p�l =$ " N b o iuit f-f�s' � x�lres. 0` �.0 � �..� �-; � .oa. ; .. �.. � :;; : � ' ' , . . ' . - - �. i:"". . � . . .. . ..,.. � . . ... :. •;..:" • , , �.•.:.. � �i,..� ••L ..•:..•. .. ,.%;� . . . :;!'. ���i a7Wtiil� �i.. .. .,,, .,..,�. . . � � .. . . . ... � i ..,,,�.,�� . .... � . . ... ... ..•.;,�: ,, � '� . .... .. .. .�..:.r. . • ' , . , �.';�'. . . ,. . ' ,.�..; :.. . .. ... '' ; {-. .. .. . ,... : ..r. �,.... .,��'. . ' ' .4:��: ��' ;�°.:•: . , . . . . � ... ..� • ' - �...:.... :: .. ,. . �..: � . . ,� . . . . . . . ...... .... .�..7 .':..::+: : ` f: �t� . . ��.I� � ' .. ,�. ':3: /. M� .(1�0 � � �40 — ) �� 'To' °�.:. tal "��: . , . . . , . .. .. , . .. ._ .._ , TI-US tS AN APAL[GATiQN F(�R A PERM2T-13QT VALIB L)NTIL PR{7CES5ED .'�iL`_ �;,Y.,, :;�i �,� .. . ;.'i: }:` :�•i': , ke;� . .',•S:° �.' u... ��`''� ... . :;i•,'° ; �y:., ��::... ... .; >�.:,. . . . . . . I herebY applY foz a p�umbing permit and i ac ledge that the i�fot�nation abovc as complete and accurate; that the watk will be in conformance with the ardiRances and codes ofthe ity af F�idley and with #he Minnesota Canstruction Codes; shat I understar�d this is not $ perz►ait brrt only �n spplicati�n for a pe�rnit an wor �is not to start witl�rrout a p�rrnit vn site; tFtat the work wil] be in accordanee with the appraved plan in the case c� a1i rk whicta u es review and approval of plans. $iGNATUftE OF APP�,JCANT '' C� �� f I � � . e.,,........ ._..._...._...._ __ _-- . --- - . PRINT NAtvtE. _ �-.�! i�.�-�M�"o.�c(n nn'r� V �l� �� �`Cl���y �uildi�g YnsQect�ons Depa�ment 643I Uzaiversity A,�vertue I�"E, Fridley, MN 55432 763-572-3604 FAX: 763-502�4977