P - 84401Building
l�sp�ct�ons
7b3-S72-3604
763-SQ��i97'7 FAX
n,ATe /d� - /(,� --%.�
3)'f"E A�f?RBSS_�e
TH1$ APPWGAN'C AS:
R�tOPBR'1`X
UWNEI�tI
T��iANT
CfyNTR,A;CTOR
SLtBMI7 A COPY O�
YOUR STA'�
LiCE2dS�, �ONi) A1VD
CER7lF1CA7"� OF
11VStlRA,NCE
PERM��' TYP�
1'Y�F ai� WClRK:
DBTAIZED ��SCR1J
From: 763 444 5629 Page: 2f2 Date: 10/17/2Q12 9:53:16 AM
�LU�BING � Permit No.: �(�17
RESID�NT�AL A�'PL�CAT�ON ( R�e1V� ay:
CI�'Y OF FR�DL�Y � nat+� � �` �
Yov� ��u. anu�ss
p QWNER ■�GCOlVTRACTUR
�+1Ab1E:
ADDRESS; --CITY STATB,_„_ZJP
PF�Q�TE:
NAME' `` � _
3T^Ta L1C�NS8 #�(,p.,,,�fi�,=/d�,i'�,.. _,.,. EXP �AT� Io� �I �/�
ST�4TE 90ND 1� �'� � 7'�,���� �r ,,�r EXk' DAT� ��� I.� _.
• nnartea, � � .� '�' �„� �/1 � I�fa!/.A%t% CiTY -iF �ALc.T; . STAT��ZIP�
7H4N� /G 5 —!
�S[NCL� PAMILY
O NEW
IOiV OF WORK _
O TWp FAMiLY
�[i8�'LACEIN�T
Fnx �..�,,,� -�� 5�.2�
p TOWNHOU3E
FEES AR$ BASED tiN 3a0.40 P�R F��'IJRE, EX�aP7' WFiER� NOTED. �X'fURFS: (a�iCA'I�'fOTA.G NUMBER OF EACH BELOVN).
�BATkI Strlxl[.AV _F40UR A�ulNS _ Si�OwE�t waTER FtPtrrG
BA'rti7il� GAS PIPING (NEEri CtTY LiC) 5W1MT�fJNC FOOL _ W�TBR SoFTTt��, fS33)
CL(1Tk1FS WA3I� � Kl"f�k�EN SIt�TlC ��+ATER CL4S�R' _ BACKF1.01� PiiEV. {S15)
_,., pl$HWASi�i��t �.,AUNf?1tY 1'R11X WATE[i HEA7`QR (S35} FOA I�,RifiAT[�TI
— wAiER NakTER _ OTFIER
pf 5��� �0.if�� x 510.�I ��S ��0 _
�$lS a0 ,,,M,,,, x 515.00 R 5��,
�� f� 5�5.90 .-- x�3S.O�P m S
�__.,. ..:, e-�-
S„�
0
TH�S t5 AN APPLlCAT[C3r� FOR 7�P$RM�T-r�0"f VA1.1D UNTiL PROC�.55ED
� heraby appty �or a plumbing pet�it and 1 acknowiedge that che infcu�sc�on sbave is aoAnplete snd accwatc; ti�at the work wik� be in
coitform�ncc wit# tht ordinances and codts af ti�e Gity of �ridl+ey s�td wit#�, thc Minnesota Construccion Cades; that 1 andastand this is
nat a pannit but anly att applicativn for a}�etrnit and work � not to sta�t without a p�rmit on sitc; d�at the work v►�il be ia aveordaisce
with the a�+proved plan in � e of i ��8rk whiah requinss ravievv and approval af pia�ns. / y
SIGNA'fCil� OF Ak��,tCANT/���r,.�• ._�_ _ .. __PIR[NT NAlN� I /',� �Of'.�rr!1"' . _. _- DATB_lD "'%G �'/.+�
City af Fridley
�uilding Iuspectloa� Department
6431 'University Avenue �iE, Fridley, MN 55432
7�53-572-3604 � a [�1`-''
FAX: 'i63-502-4977
,'.
�12