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From: 612 822 5408 Page: 2/3 Date: 7/22I2011 2:05:52 PM
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Building
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7�3-572-3604
763-502�4977 FA�
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PL'C)'�VIBING
RESIDENT�.A,� �PPLICATION
CITY �F �'�iIDLEY
YOilR E-MA]L ADJ)ItESS
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SUBMIT A COPY OF Sfn'TE I,LC�IS� #
YflUR STA'!'E -
LICEi�iSE, $C3ND AN17 STP:'T'� BUND N!
CE�iT�3GATE 43� �7���
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PERN�T TYP.� �GL� Fnhuz.X
Q TWO FAMII.1'
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Per�nit No.: � � � 1
Reccived By: � ,�
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TYPE QF W0�{t 01v�s�r �g�p�,��p
DE'�'AII.ED DESCRiFTtQN OF WORK ' .
F�F..S ARE BASED OAi $] 0:�0 F�R i�DiYiJItE, iXGL!?T WitERE N(1'C£B, F'aCft)R,CS: {f1HD1CA'i'6 TOi'AL NtJMBBR t3�� EACFI BELQVJ�• MY1+ttM[JM FEE
$3S.SQ
_$A7H �fl3IC/i.AY FY.C�R DRAiAtS ,r, 5ttt3WER _ WA7ER P2PII�i(#
_ BATiiT3}D GAS PIPiNG t'�Rt3� CITY LiC} --- S Wn�tMR�rG �0t7L WATQi SOFINF.tt (E35)
CLOT#i�s WasH�x _ KxrCHEnr Sr1vrC wnTRx CT.OSEF BhCKfLOw A�iEV. {�I S}
_ DISHWASHt;R LAtl�rDRY TRAY `wA'e�R HEATER (E35j FOR I1tRIGATti�i
y ro1+P.'t'�R ME'TER ,�,01'8ER
TIiIS IS AN APYiICATION FqR A PERMI'f-NOT VAL1D UN'T!L PROCE5SED
I hereby apply for a plumbing per�ut a�ad � acicnpwledge that thc informatzon abo've is eomplet� and aceuralc; that thc work will bc in
canformancc with fl�e ordinanccs and codes o�'the Ciry of Frid]cy and wit�, tkte I�Iinnt,ot& Construction Codr.s; that I undorst�nd this is
not a pcmUt but ooly An spplication for a ermit an wark is not to sta�t without a permit on sit� that thc work will bo in accordance
with fhc approved platl in tho li i cqitires review ar�d appro� f lans.,r%
SIGNA1VIt� Ok AFPL1[;ATi�' C������ � w_ P121NT MAM& /n1�i.a 1 1_ . Jr.—.. DATE
City of F�i.dley
�uilding Ynsp�c�ions D►e�artm�nt
6431 LTniversity Avet�;ue NE, Fritlley, MN 55432
763-572-3604
k'.A,�: 763-SU2-4977
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