P - 48387) .
Building �'�� PLUMBING nermit rio.:
Inspections - �SI�DENTIAL APPLICATION Received By:
763-572-3604 " CITY OF FRIDLEY ��°�
DATE YOUR E-MAIL ADDRESS
SITEADDRESS Se.w�t R.s D��wr R. Zeller
THIS APPLICANT IS: ❑ OW[�IER ��ONTRACTOR 6170 Carol DRive
PROPERTY Na,1�E: ! Fridley, MN 55432
�W�� ADDRESS: 7635718624
TENANT STATE ZIP
• PHONE:
CONTRACTOR N,�:
SUBMIT A CQPY OF STATE LICENSE # � CJ _ EXP DATE
YOUR STATE ADDRESS� i f^i � L/� CITY �' /1 STATE�LIP f�'l�O�
LICENSE WITH pHp� i� y03 FAX �� 7' B � 2
APPLICATION 4 �
PERMIT' TYPE �SINGLE FAMILY II ❑ TWO FAMILY - � TOWNHOUSE
TYPE OF WORK: � �W �I� �{ REPLACEMENT
/t
DETAILED DESCRIPTION OF WORK
PER MS 16B.665 the permit fee is a minim�}m of $15.00 or 5% of the total cost up to �500.00; whichever is greater, for the
impro�ement, installation or replacement of'� residentia! fixture, excluding the fixtures. (This.shouldr.eflect only.the cost of labor )
, _
.
Labor cost under $300 =$I5.00. Labor cost�between $300 to $500 = cost of labor x.OS =
�
��FOR:�ROJECTS WHERE LABOR EXCEEDS�$500,�ES ARE BASED ON $10A� PER FIXTURE, EXCEP'f�WHERB�Ni�.'I:�D..:R[XT:d3R�E�:,..(II�DIGATE TOTAL
NUMBER OF EACH BELOV� '
BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING
BATHTUB GAS PIPING pvECOCtrruC�rsE) SWIMMING POOL WATER SOFCNER ($35)
`CIAT[�S'WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15)
DISHWASHER =-LAUNDRY TRAY LWATER iiEATER (S35) FOR IRRIGATION
� _ WATER METER _ OTHER
Permit Fee $ Number of fixtures @� 10.00 x$10,00 =$
Swchar e .SO Number of fixtures @$15.00 x$1S:D0 =$
TOTAL DUE $ ' Number of fixtures @$35.00 � x$35.00 =$ 3S.Oo
, State Surcharge = $ S.� _
; .
Tota1= $ . ��
THIS IS AN �APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED '
I hereby apply for a building permit and I a�cknowledge that the information above is complete and accurate; that the work will be in
conformar�e with the ordinances and cndes ;of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an applic ' n for ermit and work is not to stark without a permit; that the work will be in accordance with the
approved plan in the case 1 o wl ' �uires •�view and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME J�'� NO/b/ON�I DATE �
i
' City of Fridley
�uilding Inspections Department
6431 �tJniversity Avenue NE, Fridley, MN 55432
I 763-572-3604 "
' FAX: 763-502-49?7