P - 35461Building PLUMBING Permit No.: ` �
Inspections RESIDENTIAL APPLICATION Received By.
763-572- �604 CITY OF FRIDLEY
763-502-4977 FAX EF�cnvE �-i-zoio �r�e
llAr� 10/26/10 �oux�.-�..�llxr,ss wnelson�ia larsonplumbing.com
srrc.�nDxr,ss 1600 Camelot Lane NE
THIS .4PPLICATt�[' IS: ❑ OWNER �1COi�'IRACTOR
PROPERTY va�: Suzanne Salo
owr�� _ _ �
TEN.�vT qnnxFSS: 1600 Camelot Lane NE c-rTV Fridley sT��MN z�r 55432
rxovE: 763-571-7996
corrrxacTOR �,,�,�;: Larson Plumbing Inc
SUBMIT A COPY OF
YOUR S'lA'TE STATE LICE'�ISE ?� EXPDATE
i..ICF.,NSF.,, BOND AND STATE BOND # E.1'P DATE
CERTIFICATE OF ,,nD�ss: 3095 162nd Lane NW ��TY Andover STATE MN z�P 55304
�rrsu�cE rxo:,re 763-427-7680 Fnx 763-427-9448
PERMIT 1'YPE Q SNGLE F�IILY ❑ TWO F.AI�IILT ❑ TOWNHOUSE
TYPE OF WORK: � ��' �PLACEMENT
DETAILED DESCRIPTION OF WORK Water Heater Re�lacement
FEES ARE B ASED O�] 510.00 PER FIXTURE, EkCEPT R'}�RE NOTED. F�TURES: (INDICATE TOTAL NUIVIBER OF EACH BELOW). MIWLV[UM FEE
$35.50.
BATH SI1�7C�I.AV FI,OOR DRAINS SHOV6�:R WATER PIPINCi
BA'I'HTtiB U.�S PIYIrU (D:EED Cfl'Y L1C) SWIMA.4ING I�OL �VA'1'ER SOF'fNER {$35)
CLOTHES R�ASHER KITCHEN SII�iC V�'ATER CLOSET BACICFLOW PREV. ($15)
DISHWA3HER LAiJNDRS' TR.3Y- WATER HEATER ($35) FOR [RRIGATI02�
— — Vl'ATER A�IFTER 07'HER
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THIS IS AN APPLICATION FOR A PERM[T-NUT t'r1LID UNTIL PROCESSED
I hereby apply for a plurubing pemiit azid I acknoN�ledge t}tat the infonnation aUove is complete and accurate; that the work v��ll be in
conformance with the ordinances and codes of the City of Pridley and ��ith the Minnesota Construction Codes; that I understand this is
not a permit but only a plication for a ermit and w�ork is not to without a permit on site; that the work will be in accordance
with the appro�-ed pla � c se 1 �ch quires appr v ��qf pl�a� ,aIO111SICl Dy� 10/26/10
SIGNAT'tJRE Ofi APPLIC r�a i ivi
APPROV.4I, INSPF.CTORS SIG ATIJRF.
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City of Fridley
Building Inspections Department
6431 Uni�•ersity Avenue NE, Fridley; MN 55432
763-572-3604
FAX: 763-502-4977