AF - 35660Date:
Owner:
Addres,
City of Fridley, M�rm..
BUILDING PERMIT
Builder
Address
N° �4682 '
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��' L4C�►TI�N �F� BUILDING
� :. � � � � &�' , � '"
1�10 �--�-�-�=-�-- Street _.._.._2 -----�.�-._�.�� •--�....:.��� '�'F.. ..................._......._..._ Part-,oi
Lot .... �. ! . .............. : Block ....._.. �.�_.......-------- Addition or Sub-�i�ision��.�;
�.
Corner Lot .--..... '�""�..--.-.--.. Inside Lot ------. . ... .._ ... .... .... Setback,,� . x r �F �� � c
5ewer IIevation --.-_--_-•------•---.•----•--.._....._...------------.---.•----_..-----•--........_........ Foundation Elevation
DESCRIPTION OF BUILDING
To �e Usea as �'- � �t'�6......_.. F . �
� , � .:� :` �' � . �'� �` � Depth .:a�.. �,...._.. Height a � Sq. t �::�� �`� Cu. Ft. ..� .:,z� �
� � � E � �, �.
,,�,�.. . �...�. � .,� : :x_ Froni �. _�..._.. .�._,. :
...._ �...- ....................... #Fron� ... .. Depth ... .._ . h��"'Heig . . Sq. F�. ....:.._....._...._.. Cu. F't _..__... . ---
.: - .I . '� '" a� f �+G�� `r� �'��
Type of Construction °���; ,..� . ..� r.:z „�:. a _� :G'... . Est. Cos�``.... .....�; � ........ �.�='..---.. To be Completed --- --......_.....- ............._.....-----......
�����A�� `�
THis ��Rn���r �`�c , r,a� �-i AI.ITHC��l7_� v�o�AT-
ION OF ;',I�dY f';;1' �; � E Lft���i� �v��P;;�faTS AN�
BU�I�Gif'it; FCt�;l'ra;��,lC�;;';.
In consideration of the issuance to me of a permit to construct the building descrii�d above, I agree to do
the propased work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley. �
-�---- -��......_..._.._�._._.._. .._.._.._.._.._.._
�,� �; ,�.;.
In consideration of the payment of a fee of $..;�._�_°-'.'."�..., permit is hereby granted to._.____..__..__._........._.
',:._..._..._._.__......_____....__...._....__..... to construct the building or addition as described above. This permit is granted upon
�he earpress condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
�'riidley, Minaesota regarding location, construction, alteration, maintenance, rega.ir and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. �, ,� �.�°' ,
�` � ,,+� ;;
'� '- "� ' -__�_.... ti,.:�� Buildin tor
.�_�.... --,��-. �----� „ g InsPec
NOTICE:
This permit does not cover the wnsfructton, inetallation for wiring, plumbing, gas 6eating, sewer o� water. Be sure to see
the Buildin8 Inspeetor for separate permffs for these items.
r'�l
�;.�. W..:._.,.
4 �°�,
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. $PPLICATTON FOR BUILDTNC� PERNBT
CITY OF FitIDLEY, MINNESOT�
� - :. � � : , � ,�: . i � - �, y • = 1 , � �. � � - . y
AC�CIT@88�o_c� 5.+.����Y1r�. . % • ft . ActCi�'868.� °� �o � . �. �, �'�",��, S �'. �YI �,
LOCATION OF BOILDING
No. �`� .�„ � Street � ea.,� a`i-ea � Part of Lot c� e> 1� �, "�,
. --
i�ot �L , Block "�,______ �dition or Sub.D�.v��� )s,�s� /�g �i r � •
�. � .,..�
Corner Lot_�,Inside T�ot Se�t Ba.�k ' Side-Yard
SEWFR ELEVATION FOONDATION ELEVATION
Applican� attach ta this form Certificate of Survey of Lot and proposed building
location. .
DESCRIPTIOIV OF BUII�ING
To be used as:
� �. r �.���,,,�,_ P`ront �i � P Depth_ �. �J ", He3ght % � �
Sq. Ft. �Cu. Ft.
�'roni Depth - He3$ht
Sq. Ft. Cu. Ft.
T�pe of Conatruction � r c� r,�, p_ Eatimated Cost '��eS �,
To be completsd ,� �) � �� � �w.� � 9 � �
The unders3gned hereby makes application for a permit for the work herein apecified,
agree9.ng to do a11 work in strict accordance with the City Ordinances and ruling of
the Department of Buildings, and hereby declares that a11 tY�e facts and representa-
tions �tated 3n this e.pplication are true and correct.
na� � I �.� � � � src�u�°� � ��,�, �. . �.,�,.���-.
(A Schedule of Fee coats ce.n be f'ound on the Reverse Side.)
T`�
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: i � ► r . - �. _K � a� ��ri i �
Sect3.on 2. The Inspector of Bu3idings shall, before iseuin� a�► Perm3.t ,
for the erection of au� bu37.ding or stivcture, or for any addition to
any existin� buildin� or afi.ructure, or for any alteration� or repairs
to any sxist�.ng building or atructure, upon application therefor� require
ths pa�ment by the applicant for such permit of feea to the amount herein
below set forth and in the manner herein provided to-w3t:
� a � T i
2.1. For an� such permit fcr the erection of an� f3re-proof build�.ag, other
than a garage; warehouae, factor� or grniu elevatc►r, o� for the erection of
any �ireproof addit3on, for s3milar oceupancy, to any ex3sting 1at3.ldin8
ehall be at the ra.te of �l.!*0 fox each one thousand cubic feet� or fraction
thereof, in such eubica]_ contenta.
2.2. For an�: such perm3t for the ereetion of any f`ireproof gere,ge, ware-
house, factory ar grain elevator, or far the erect3:on of any firsprooi
adclition, for s3.m37.ar occupancy, to any exist3ng build3ng eha]1 be a�t the
rate of $]..25 for each one thousand cubic feet, olassified as "�ept'oo�"
by Section 502 of the Minnea.polia Building Coda.
HOUSES
2.3. For any such permi.t for the erectioa of any non-f3reproof building
other tYian a garage, warehouae, fact� or grain e].evator, or any no�
firepraof addition, for sim9.].ar occupanc�r, to a�n�t ex�.-et9.ng buildiag.
Permit $1.00 for each one thousand cubic feet.
GARAGES
2.L�. For e,r� such permit for the erection af an3+ non-fireproof garage,
warehouse� factory or grain elevator� or for the erection of any non-
fireproof addition, for similar oecupancy, to ariy existing bu3.lding or
for each auch bu3.lding or addit3on. Ninety Cents for each one thousand
cubic feet or fraction thereof, in the cab3cal contente ther�of �3.th a
minimum of $4.00.
For the pu-:pose of computi.ng fees �or building permits the cubical contents
of ang building or a.ddition to a uniform height throughout by multiply3ng
�he ground area covered from a point six (b) inches below the f'loor 13ne of
the basement or cellar to the anerage height of the upper surface or tn the
aeerage height of the roof aurface of the main ga.ble of a pitched roof.
2.5. For repa.irs or alterations to an exiating atructiare, the fee aha11 be
at the rate af $3.00 for each Five Hundred Dollars (�500.00)� or i�action
thereof in the coat of all proposed work.
2.6. In no case shall the fee charged for an� perm3.t aa set forth 3.n
Section 2 be less than �4.00.
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CHIM�JEY AN� STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes (�)
2. Is free from rust or deterioration Yes ()
3. Has no foreign objects lodged within Yes ()
4. Is securely supported Yes ()
- -- - -- --- - -
5. Meets all current Code requirements for size and
total BTU connected
6. Has Total hea ting BTU's of
Al1 other BTU's
TOTAL
Rema rk s
No ( )
No ( )
No ( )
No ( )
Yes ( ) No ( )
Com pa ny
Signed By
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SUBJECT
City of Fridley 2 6 4 6 2
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
� � RECEIPT NO.
� i L�_�_� COMMUNITY DEVELOPMENT DIV.
r � � PF;OTECTIVE INSPECTION SEC. ���L�
i i i
� /'�'1 � CITY HALL FRIDLEr 55432 NUMBER REV DATE PAGE Of APPROVED BY
�""'"� � �'' 612-511-3450 910-F15 7/6/98 / /
JOB ADDRESS 5268 Capitol Street NE
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACNED
DESCR. �]. 7 Carlson's Summit Manor South Addn SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Joel P�.ulsen 5268 Capitol Street NE 572-1150
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL AOORESS IIP PHONE LICENSE NO.
5 ENGINEER MAII ADDHESS ZIP PHONE LICENSE NO.
8 USE OF BUILOING
Residential
7 CLASS OF WORK
❑ NEW �l ADDITION 0 ALTERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Construct a 14' x 10' Deck
9 CHANOE qF USE FROM TO
STIPULATIONS
See notations on p1an.
i
� 1NA� ���
� Before digging caN iot
all utility locationa
454-0002
�EQIltRED BY LAiI�
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OH IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTEH WORK IS COMMENCED. NO. DWLG. UNITS OFfSTREET PARKING
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION ]. STAILS GARAGES
AND KNOW THE SAME TO BE TRUE ANQ CORRECT. ALL PROVISIONS Of LAWS yp��ATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOfiK WILL BE COMPLIED
WITH WHETHEFi SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �1,255 �.63
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEfiM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORM CE OF CONSTRUCTION. ��F3.00 Fire .S�'i �1.26
� PLAN CHECK FEE TOT EE
.89
SIG U EOFCON'RACTORORAUTMORIIEDAGENT IDATEI HE PRO VALIDAT F�IS IS �YJO/UR� PE IT
- / ! (,/
SiGNATUREOFOWNER�iFOWNERBUILDER� �DATEI "�B G INSP rya7E
NEW
ADDN
ALTER
[ ] Effective 1/1/98
[ l �;,; ; ; ,:: . CITY, OF FRIDLEY .
� SINGLE FAMILY -AND DUPLEXES R-1 AND R-2
� BUII.DING PERMIT APPLICATION
constructionAadress:
, . � �� �� ( �� � �-L � �
Legal Description:
Owner Name & Address: �� � � 1l % .� -� � ) Tel. #. � `7 � -� 9 /. S �
Contractor: _� � �.�. MN LICENSE #
Address: . Tel. # �i � `�,;�Z S �
' ` Attach to this application, a Certificate of Survey of the �
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA: �
DECB AREA:
01'HER•
DESCRIPTION OF IMPROVEMENT
Length }�_ Width �- Height Sq. Ft.
Length Width Height Sq. Ft.
Length IL� Width i� .� Hgt/Ground ��" Sg. Ft.
. �
��c-�r-
Construction Type: (,� c� � (Q ' Estimated Cost: $ / �,j �a (?
-- - (Fee Schedul e on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: � � � �-�'I � APPLICANT: � Tel. # � �7 a.,� % 7 s �
CI1'Y USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ 3�a�
$ �.-��
� r�
$
$
$
$
$
$
ij�
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,Q00 ValuatiOn
$1000 per SAC Unit '
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering "
Agreement Necessary [ J Not Necessary [ J
.
.. . . :'" � i-� �. . . . . .
BUII.DING PERMIT FEE SCHEDULE
;r . _
The Cluef Building Official shall, before issuing germits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
-_ _ _- TOTAL VALUE
$i to $S00
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $1Q0,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,0�
$62.25 for first $2, 000 plus $12. 50 for each additional $1, 000
or fraction thereof, to and including $25,000
�
$349.75 for first $25,000 plus $9.00 for each additional $1,000
` or fraction thereof, to and including $SO,Q00
$574.75 for ``first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,(�?0 plus $5.00 for each additional
$1,0(}0 or fiaction thereof, to and including $500,�
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012:25 for the first $1,000,000 plus $2.75 for each additional
$1, �0 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A°: Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate °B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION .
Permits for construcdon will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
1
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sue�ecr RMIT NO.
c�ty of Fridley 2 7 2 � 7
AT THE TOP OP THE TWINS g U I L D I N G P E R M I T
r
� �` ._�� COMMUNITY OEVELOPMENT DIV.
� ~ � PROTECTIVE INSPECTION SEC.
r , ,
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� _ �"'� � CITY HALL FRIDLEV SS432 NUMBER
�"""� � �'� 612-571-3450 et 0-Ft 5
JOB ADDRESS
5268 Ca itol Street NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 21 7 Carlson's Sut
2 PROPERTY OWNER MAIL ADDRESS
HEV DATE
8/17/98
RECEIPT NO.
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PAGE OF APPROVED BY
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SEE ATTACHED
SNEET
Joel H. Paulsen �ic-���v
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
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Own.er
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
e dent
7 CLASS OF WORK
❑ NEW ❑ ADDITION � ALTEFiATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOHK
Reroof �ara�e (10 Sq) 2nd Layer
9 CHANCiE OF USE FROM TO
STIPULATIONS
Roofing can be 2nd layer but not 3rd.
TYPE OF CONS7. OCCUP/
SEPARATE PERMITS ARE REOUIRED fOR ELECTRICAL, PLUMBING, HEATIN(3,
VENTILATING OFi AIFi CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OFi CONSTRUCTION ZONING SO. fT
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AfTER WORK IS COMMENCED. NO. DWLG. UNITS
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 626
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEFM1T fEE
PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGULATING CON- �
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. L(').SO
PLAN CNECK FEE
SIGNATU E OF CONT � CTOF OR AUTMORIZEO AGENT IDATEI EN P OPE
� U E OF WNEA 'F OWNER BUILDERi IOATEI BL NSP
0
OCCUPANCYLOAD
CU. FT.
OfFSTREET PARKING
IGARAGES
SURTAX
$.50
SAC CHARGE
Fire SC $.62
TOTALFEE
62
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ConstructionAddress:
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
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Effective 1/1/98
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Owner Name & Address: `�o� ' j-� � ?� � S �_ � C� j� � r ,� � Tel �# � 7 � J J �
�--P��-�
Contractor: � �,, �- �? -� MN LICENSE #
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
�THER:
Construction Type:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height
I.ength Width Height
Length Width Hgt/Ground
�1--� � � � ,� C�y- .� � -� ,�
Driveway Curb Cut Width Needed:
Tel. #
Sq. Ft.
Sq. Ft.
Sq. Ft.
Estimated Cost: $ ��io �
(Fee Schedule on Back)
Ft. + 6 Ft = Ft x$ ___ _$
�% (�,�1����°
DATE: � �`�? "� � APPLICANT: Tel. # s `� � 1 i ��i �
CITY U5E ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
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$ ° %�
$ < ��
$
$
$
$
$
$
$ � . �
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (Sta.te Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
, �
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500 �
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,Ot}0
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,0�
$574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $1Q0,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Altemate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.g�.
Altemate "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
vERIFiCATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application �o allow for prop�r
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has �een construc��d
will be required before proceeding with the framing.
�uilding
Inspections
763-572-3604
763-502-4977 FAX
DATE � I = �-
SITE ADDRFSS �
THIS APPLICANT IS:
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3�� � i '� , t�� � '� � ;
i�? c � ���� '3a � � $ �'3 � � ��'� � . �� i,b i,a i . 5 � �� ± � '�,� ,;
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YOUR E-MAIL ADDRESS
OWNER �'CONTR.ACTOR
Permit No.
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PI�O�ERZ'Y'Y NAME: ' Pi
O�VNEfl2/ �D�S: CITY STA ZIP ��
T�I�1�.NT ��' S4
PHONE:
COl�'T�CTOR NAME: Cll�iil-�I�i1 F�'IU�"t�ll'lg
SUBMIT A COPY OF STATE LICENSE # #�1770-PI�A EXP DATE
Yaux sTa.� _
LICENSE, BOND AND STATE BOND # � EXP DATE
CERTIFICATE OF p�DRESS: � �r+� I�A�� ��� �� CIT�' STATE ZIP
INSURANCE pHONE FAX
fl'E�IT 'I'i'�E
�'I'P�+ O�' WO�:
�SINGLE FAMILY
l
� NEW
DETAILED DESCRIPTION OF WORK
❑ TWO FAMILY ❑ TOWNHOUSE
�tEPLACEMENT
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FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
BATH SINK/LAV _FLOOR DRAINS _ SHOWER _ WATER PIPING
BATHTUB GAS PIPING (NEED CITY LIC) SWIMMING POQL _ WATER SOFI'NER ($35)
CLOTE�3 WASHER KITCHEN SINK WATER CLOSET _ BACKFLOW I'REV. ($15)
DISHWASHER LAUNDRY TRAY �WATER HEATER ($35) FOR IRRiGAT'ION
— — WATER METER _ OTHER
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance
with the approved plan in the case of all �ork w� �h re uires review and approv' a� f plans.n ^
SIGNATURE OF APPLICANT
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tCi�y �f �+ �-id��y
�a�i�dang �nspectfl�ns �ep��mea�t
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
' FAX: 763-502-497?
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