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P - 42106
Bu�i�d,� Tx�.spections 7�3-572-3G44 763-502-4977 FAX 3FSE ADDRESS � � -rH�s n�rz.ac,�r zs; OW�I��t/ �� SUBMIT A COPX �� X01JR STa�rE �,ICC�NSE, BOND AND c�R'�cA,'�7E o� zr�sv�rc� �EIftMIal7t` '�'it�P'� �t1rn� o� woRx: From: 7635193932 Page: 1(3 Date: 5/13/2011 2:48:03 PM �"'��:T�B►�Cx �S���TTIAL APPLICATIUI'�T ���X �� �����X YOUR E-MAIL AripRESS ❑ owhrsR f�corr�tAC�oR NAN�: '� �j �� � Zc.� !'h AbDRES3; j Ln r y`J 3, �_ ��t� �rnv�: �l fo3-''[�l3° 9 (o5E8 xa�� �c:�.-_�'t, e y' STA� �.TCENSE � � r _ 3TA� BONx► # � r%��,,� (0(0� � Annr�.ss- I`�15;�i a� � A,�y.c rxor� � Ga�.�_.1..� � �`iU � �Slixct.� FAn�u�,x ■� o �zwo �,n�z.x ❑ �r�.�ac��ivT �'e�nit xeceivea a�+: clt�x t=r�� (c.� srA-rs��,lzrp�,�;2 � �A� /� 3 t- 1 c�- �'la,A� l+�',�f- �l _c�rx '� h _s�'���z�S �l ' _ �,� � � 3 � ��15• 3�3 �-. , c� �owr�ous,� D�7e.�t.�n A�esc��ozv o� woiut k�,�� �xd c e�" S t c� c�f 5 t�� �M e� e r vct t �� 2 �$ ,ARB BASLU OiV S1U.W Y�iL ET�'�[JRE, EXCEPT WHERE NOTED. EEk77JRES: (I3VDICATE'[�OTAL NUMBER dF EACH BF.L,OVY). ]1+�1�(J,I� Fb� 53550. BATH SIIVKli.AY F(.Qpl� DRAiNS SHOWER � WA'f�t P�l�(3 _ BATH'C[1B GAS �C3 (N�D CI'fX �.1C) �' SWZir�'�iG PUUI. wA'�R SOFTNER (�35) cLO�s wast��. —� �.tircz�nr smrK —wa� cr.os�r —�a,�c�..ow �v. Eaas� _DI5HWASHER _ I,AiFNARY'IRA,X W.�'t�R k�A.'�t (S35) Ft7R T�tRI�A'�'InN _ WA,'�R IN�R _ O'�'�i�t 'N�nt� of�s � �i0.00 x ��o-oo = S . : �nbe,� o£Z�um�i+e�'(c� �$�S.00 = ;�To�b�' a►��ceauea,(� �iS:Qp� State Sttrcltatge� . � . xS�5.00=� � x �35.00 � S ,..�� �t� � � �. M+L�E,�l7.0 �� a Z "' V — TH[3 I3 AN A,�.xCA�'�ON kq�.t# �T N07 vq�,�D tJN17L PROCESSED I hereby appiy �vr a plwmbing p�erm�t aad i acknawle,dge thst tlu information above is cotr�lete and accurate; thst the work witl be in canfor�r�a¢oe wxtb� #b,e oxdioanoes and cod� of the City of Frsdley and with the Mitmesota Con�txuotion Codcs; that I undeista�d ti�uis �is x�ot a peimit buk only an appiica4on for a�i� and wo� �s mot to stari wiittAOUt a pe�rf�it on sitc; thsi the work will bc iaa aocordance with the a�e+nved plen in dae,p� of a11 wor�G h re�u3t�es �evii�w a�d appmval o�p�ans. c�sg34 /- /°�!j sxc�n,� o�,�c,,�nr ���.�--�yd��-- . �r rrAn�r.E �D,�: F�! t� � a�, � nnzE 5'�f3/f�! AND MECHANICAL WORK City of Fridley Bu�Xd��g �t.spectaa�as Department 643 � Utzive�s�ty Aver�ue NE, Fridley, Iv1N 55432 76�-572-�6Q4 F.A�X: 763-502-4977 e