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P - 48430
��_ � �1�� From: 612 822 5408 Page: 2/2 � � � �.� �� � �a Date: 2l23f2012 4:42:4Q RM `�c� -� ��C��i�,,� � �1�.1�C'�1Y1�, �� ��r��Bi���` Permit No.��i�a0l� I�n.s�ections R��II��I�TTIAL APPLICATIO�T �.��avea �y:�i _ ���-s�2-��04 �i'�'X O�' �I�D�EY' D�� x.��a; . 763-5+02-4977 FA.� ,�FFcxivE i-i-zoix ► DA'FE!� � �C:=S: Ij"�- YOt1xFrMA14ADDRES5 _ _. �. —..�._..�....�.,.. 51TL AI}DItESS `7 z�i� �p�,icnrrr �s: UWPlERI TENANT S�MIT A COt'Y UI�' 'YOt3R. STATE LI�ENSfi, B4ND AN� CER'TIF�CA'tB OF INSURANCE PEfth�111' TYPE ❑ awrtr�t Jac��rrri.4�-rt�x r�'g�'�• j� -//`� � i: � �'�� ..��- � ,Q--f � 1"`� �- CTfY, 7,� 3 S-7'? _ �"i �'^7 � S'I'A'I'tiLIG4iNSh# � ��� STATE BOND tl S1lV(i6� FAM[LY TYPE OF WORK: I � �w ' 7Ldry FAX ❑'i'W() FAMIf.Y C]'TIJt�VNkT0U.5F.. �R�PLAC�MEN"T T��TAII,En DESCtt�'1�t01v t7r wORx i� � Plrc✓ � 3�.��Jt�i� f 1�T� ���: ,�;�z / 5KP I�AI'ti _ �., .. _ �XF LIATE 15gOL I f. STA'f&,�/�! Zip ����„ r FFL�.S AR� 6A38D 4N �{O.flO PF�t FIXTUIbE, EXCE{�T WI�I�E A�OTED FIXTZJii�S: (INDICATE'I�TAI. NtJ1vIHER OF EA�i�[ �SI..Qw). MiN1MUM FF.� S3S,50, nATl�ISINKILAV „ FLOURL�R.AiN� SH�WFK ?�WATQtPII'[NG sA'r�'N� ^ GA5 PIPING (NEED C1TY LIC) SVVDvIMINC P00L wn�.x SQr'fN�1i: ��35) CLOTFiFS WASHER KITCI�ISIIVIC WAT�RCLOSL•T RACKFI.c)W PliFiY.{$t5j _ DISFIWA5II�R � LAUI�iDRY T12AY WA'I'F1t HkA1'F.12. (�S3S) FOR iRRIGA�N _ WA'T'F.'R MF.TFR _ OT!•IGR � THI9 i3 AN APPLICATI{7ri �QTt A PERMIT•NOT VhG1D UNTI�, PROCF556a I hereby apply for a plum6in�, penrit and T acicnowted�e that tJte infmxinatian ab�ve is con�Plete and accurat�; thAt the work wiIl be in coufo�ance with thz orclittances Futd codes of the Ciry of �ridley uud wit6 the lvlinnesota Constructipn Godcs; that I �zr��erst�nnd this is not a pern�it but anly an spplication for a permit and work is not tu start wilhotit a pertnit on site; that the wark witl be in accor�lance with thc appravcd plan in.fltc sas Hrwg"'�r " h rcquires review and app,I4�t �1 of plans. ---• �� i Sl'GNAT[JR� C7P APPLLCt3N1' ct: '�� �""— PRiNT I3AM1E -� � ��'L.L ��`CP�GtiV GATF � � _( �`� ,_�„" ...�w...,.. ....,.,.,,.....�..� � �. _--� _ . __ , City of �'ridl�y Buil�ling inspections Uep�rtmcnt 6431 lJ'niversxfiy A,venue N�E, I'rid�ey, N1N 55432 7f3-572-3604 FA3C: '�fi3-S42-49'17