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P - 48478From: 612 822 54Q8 Page: 2/3 Date: 2l24i2012 4:23:53 PM �'� ��'/C� � -� � �i �� 7. � �G� � �`� f�zi �.� � , ` Building ' �'��MBING ��nn�t NQ Ins �tian� _ _ � ' + �I�,1�NTI1�L A�'�'".�,I�A 'f� Received By:.�' J ���-s�2-36p� CI'TX OF FRIDLE� � " 1 7�3-saz-���� �.� ------- - - --. - R��� � B 2 l DA'T� �� 1r�f! 51TE AnT1itE33 rni T�iLS APPLICANT I5, owrrr� TENANT YOUk E-Mn[L ADARE35 � owsv�az �coxr�acro� SUBM[1' A CnPY �F -.�_. ._ v. _ YOIJI� STA'iT� STATE LtCtiNSB Y.IC`�3N3L�, iiUND AT� STATE HOND �l _ CEI�TIFlCA�rE ar ,an��x�,ss; �� iNSUIiANCE PHON� 12� PERMIT TYl'F, � �51NGLFs FAMILY TYPE O�"RVOItK: � o NEw � [7 �� ❑ 9'WVt� FAMI�,Y [�'h.�PL,a[:�M�N�r 0 �XP 17ATFs EXP DAT� '1 Y IN N�-tiPz'L f r STATE�ZIP � � FAJ{ 0 TOWI*!1�lOtlS�; � 17�'1'A1T�E+D DESCRTi'TZQN Ol� WURK �L; c��� t„�% 7 �.7� . �� � FEES AIiE Bt19TI7 ON � 10:00 PRR FIXTUR:�, �XC�7' W HET� N4TCD. PTXT'(J22ES: ([►�DIGATg Tfl'f'AL MIMBEI� OF �AC.�I D�I,QR�: MIIz1IMIJM F� 535,50. BA'I'�I S�TUI.AV ,,, - F4UOR pRA,IN3 SHOWER WA'PEit I'lYING _�A�'F1'� GAS PIPING{N��p Cr7�7t LIC) S'N✓✓ln+wi[ntC. Pc.�Ur. WATER SOFINER (335) _ CLOTII�s'" WASI�L _KITCFIEN S1NK WA'I'hR C:1.05FiT DACKrLOW FRL•'V. (�i8j — ��I�'��� _ LAU1Vt7KY'I7i14Y �WATER HEATGR (S15) FOR IT2R1ciA11GN WATGR MGTER Oli�IER THIS iS AN t�'}'LICAT1pN'FORA FERMIT•N07' VALli7 UNTIL PR(3CS$$ED � I hereby apply for � plun�bing peiynit nd t flcknawl e tl�at the infarmation abovc is con�plete and accurate; that the work wiil be iC1 COttrOi'111AnCC vYith thc ordin�C@S flilfl CU � ofthc .i of Fridley And with thc Minnes�ta C�n,struction Codes; tt�at 1 understaud this is not a permit T�ut pnty �it a�plic&tion i�ar a p i< work is nut to start without a �aermit vn site; tliAt th� wor� wili be in ac�ordancc witIi the a�provod plan irk�e-ea�af ll wa+ r '� roquires review and a�nroy,�I ofpl�tns� _/ SIGNAI'UItE f)F APPLIGAkIT' ,� : /IYk1N'I' NAME i��s�".� � �'7��,a+iu naTr 2� 1��.: R/ I Z �( Cit,y of Friti�ey Suildiung Inspections Aepartment 643! University Avenue 1�[E, Fri�l�y, MN 55432 7G3-572-3G04 FA3�; 763-50�-4977