AF - 44140�
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City of Fridley
r aT TNE TOP 0� TME TMn�Y
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Kind of Building
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Comp etion Date
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iI��ECT
PLUMBI�r, PERf9IT APPLI�ATI���d
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Ad ress
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Use
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— - --- -- _ - -- _ �°S' °- c— ---- --
Plumbing Fixture Rates: N0. RATE TOTAL
Number Fixturea � x $2.00 ��
Future Fixtures x $1.50
New Fixture-Old Open. x $1.50
Catch Bastn x $3.25
Water Heater-99,000 BTU _� x $3.00 �•�
Ground Run Old Bldg. x$3.25
E1ec. Water Heater x $2.00
Gas Fitting Fees;
lat 3 Fixtures _L x $2.00 �•v—J
Additional Fixtures x $ .75
Gas Ra.nge-199,000 BTU x $5.00
Repeirs � Alterations
See
Deacription: Code
State Surchart�e .50
�
j TOTAL FEE $ �,3- S�l�
�
!The undereigned hereby makea application for a permit
for the work herein specified� agreeing to do all work
in atrict accordance with the City Ordiaancea and rulin
af the Department of auildinge, and hereby declare that
a1l�the tacts and represantatione atated in this
application are true and correct.
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'S gnature Date
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A�.P1�IC�,7°I��1 ;F�� RE�I�Ehi�'���,. ��T�1�i��31V,
QR, ADA�TIaN �UILDTNG P�RNdT�'
��T'Y OF PRTA�,��'s M�NN��oT�#
��� �. G�L�� ��� c ���:� L �� � � o ��� s�
ADDItES S ° % � 1 � r� � /i Q....r N /S �' L�?�S s i ,,,,� � 7..�..,.?�,d12. � ife'rsC �?' � � �«{
�t�b . ! 3 S�'��,�.�,.��^ � ,._.�.....,
�x / � BLOCK i ��, ��zOAT 3� .,�Vs ✓� e��
e t � � �
�C;Q�R LOT; �:�E LO�:� v SI:TBACRg �' �e � SIDEY�iRD: l„�,�1 !
„��,�,�� ��� ���+p��c Certificates of SuiveY o� I,c►x a�d propp�ed
fimti,��� �iAesti.� �d� � #�$e Cartificates.
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F��C�i�TZQN OF �UILi1IAiG
-� � i� A� :
Ho � s c � � � ��: � � �ee��t: � o
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4 �° � ° �°' �, � : �-' �;
Sq�aace �'��� �2�=�-� �'C+��riae �'tCe�3
GH ��c e ��: � 7 � � �:: ��� * � � se�.�ht ; 1 � , , ,
�„�aw��, � � a e �
�— �
�ua�� �'�et; "_� `� - Cubic Feeti - _
�� of �oa��9�xue�.�� (�rs��rll ,F'11,�1� ��tim�a�ed Cost: ,��� S�O
�..w�nw..l�. n� (y
� F :: A� � ��' �"'i' 't�..:.
�r� � 4��'l��e�cl � � , % _ : � � . , � f R
��s��#�ed hezeby a�lc,e�s a�l�a�tinu #or, $ pe�t foz the w��ck fi�rei.ad
��t,f�#ed� agreei.s� to do a�� �� �.n att�ct accordance witYa �he� �.ty s�
F�,dA�' A�+��,�s�� �d �t� �►f �#e De�ar�ten� Af Bu��di�8, �'�e7reby
��+e� � a�.l #�� �a�cta �d ��reserita�3.one �tated � ta,i�.� appi�,catian
�� � at�d aa�rect� .
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'� s�D�� � � �e Iwia�+��m � [T.
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��9_�it+�,►�re S�.d�i �o� Add�t�onaZ Infosu�atiaa�) � °"F'� L°._' � k'` � �
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��U��ATNG ��RMIT F�� S�H�DU�E
���T'�Ql� �. 'I'h� Inepecto� pf $�i.ldi.ags sk�all, befox� i.esuiag pernait� for the
����tion o� a.ny bu�lding o� structure, ox for any addition to any �i&t�mg
bx���d�� ox strttGture, ox fos any alteration or xe�airs to any ex��git�g
��a�,�.�� o� stxucl�u�re, upo� �,ppl i,�ation th�xeft�sey xequi.ze the pap�t�� by �he
a�g:�.ia�t fv� su�1� p�x�,t o� ��es tro the ataoun� herein below ser fArkh a�d �.n
��a� �t��x h�x�e�� g�avided � �o*wi� z
UI�FQRM �iJZLDTNG COAE= TyPe Z� Z� 4-$2.15 �or each a�rae zt►ous�c� cubic
fe��a �� f�ractioa th��rea�, in �t�� cubical coa�ents . 7rype 3� 5=$�..85 �o�e
�Cb ons Ci�ousand �tb�.c �QeC. •
A�D�T�UNAL �NFa�T�ON
Fc�� �� �fu�'�A�e af Caaapul�� �ees for building peruti.ts, the cubical 'cantents
oE asey building or additian, i� det�rmi�ied by mui$$plyin� �he g�tound area
���i �'�na a� poitt� s�.ac (�ij in�es b,�low the f�oor iine a� the basemex�t
� t�#e �+��.�a�' �o C%e average �ieights of the uppez surface or to the avera��R
:�i�it �€ �e �oc�� ���ace vf the maip �ab�� of a� pitched xvof, �
��ti� o�c al����x�o�s �u an existin� s�ru�t�ceF �tae fee shall. be a� �h�
��.�� o� $�.�U �e#� �trc,� five h�lcised dollar� ($30Qo08) ass� f�'�t�t�.on th�x'sof �.n
i�e cA€�� �� a1�. p�og�aed wox�C.�
7a� �+ �at�e ��.a�l I�b� �+�e �d fo�r � pe�it as set �o� �n Se��ian 2 be
�.�t t.%an $S.�i.
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1������1iTiQN 0� ��}[1NDATI�N
�4�� I'�ts ��a� �o�at.�ut��.oat wi��, be i�$ued a�ia��.� o� �4 i�c3urs ��� ths
�� a# �pplicatf,vs, �� a���a �o�c Pra�►ez review ot �he �roposmd s��u��ture amd
p� �e �st�u�tion ai�e.
' � ���.�i� �u�v� v� �h� is�„ �i�ta� � �ocat.�; o� �th� €auuct�ti�, ��� ��
�� �� ����t��i�, wiii �a �equired be€ore pr �oce�din� w�h the� fr�n�,
C��T'TF��.A'i� QF (���PAN�Y
��.ia�ttia�a ��� a C������ataa �� Uccupancy �hall bs mad� teu (1Q) �Y� pzior
�o �h� �t►se c�� ac�u�palaey a� �ay a�.c�sze �or which a bui.ld� pera�i� has b�an
isst�a�d; �ttc� sa�id at�G� �}�al� �ot be ased o� occup�ed uatil a C�x��.ficate
of p��upaa�ay har� bee�t �sao�d„ .
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4
�� OF FRIDLEY
� aO-
1�� _431
Applieatiom for InstaIIation of Water and Bewer Bervice
This form to be completed before a ta,p is made to any existang water
or sewer line. � �
Lot .._ ��P._......_.---- Block ---�--.._...----- Addition!!� .d.�2�d� V� `� ���
Address .�'_.u..�._.r.� .
-� --- •-- - ---.L�������_.��...._
Owner ----__._._'�C�� _ �_._. _____._----
Plumber .�✓�?��?�a..✓_ �_. _. _. .... _.
(this portion of form to be completecl by on requesting tap)
CHAI�GES TO BE PAID BEFORE TAP IS MADE —�±VfiERE
ASSESSMENT HAS 1VOT BEEN T•�'n AGAIl'cTST P.ROPERTY
Sewer Connection fee
'�Street patch _.�
Water Conaection fee
Meter degosit
Materials used
�Street patch _
�
�►�', o-�
�' WheTe appHCB.ble r
The above appHes for all regular resideatial size services
IF LATERAL ASSESSMENTS HAVE BEIIV' LEVIED AGAIIVST
TI� PROPERTY, TI�R.E WILL BE NO CHARGES OTF�t THAN
CONNECiTON PERMITS AND N�ER DEPOSIT
The City will furaish materials for water service and the plumber
will bill the City for sewer, not to exceed $3.00 a foot or a maximum
of $60.00. _ _
ASSFSSMENTS TO BE LE`i.�D
Credit for ma.terial
Total assessment
Sewer Lateral
Credit for material
�i �i, � a
$--------_.__.._____.
$_...----•-----_._.._._....._
$_..�_.__.._.__..._____..
60.00
Total assessment $___.._.._...._._._.____
Clerk's signature ���� � A.�����p,�.��5�.
I hereby authorize the above tap
1at copy—Public Worka Director of Public Works
sue�ecr P N .
City of Fridley 6 2 9 6
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
; � RECEIP .
� • COMMUNITV DEVELOPMENT DIV. �rJ
� •y ������� ��� � /
r � � PROTECTIVE INSPECTION SEC.
� . ,
� ` r"'1 � CITY HALL FRIDLEV 55432 NUMBER REV OATE PAGE Of AVPROVED BV
�'"'"� � �'' 612-571-3450 910-F15 6/17/98 / /
J08 ADDRESS
7513 Central li�enue NE
1 LEGAL �OT NO. BLOCK TRACT OF ADDITION SEE ATTACNED
DESCR. 16 3 Don's 5th Addition SHEET
2 PROPERTY OWNER MAIL ADORES$ IIP PHONE
Pui Sui Tam 7513 Central Avenue NE 786-4545
3 CONTRACTOR MAIL ADDRESS Z�P PMONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL AODRESS ZIP PMONE LICENSE NO.
8 USE OF BUILDING
sidenital
7 CLASS OF WORK
O NEW � ADOITION O ALTERATION �] REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
of House & Gara e 24 S) Tear-off
9 CHANOE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMB�N(i, NEATING, �PE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD
VENTILATING OR Ali; CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OF CONSTRUCTION ZONING SO. FT. CU. PT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOFi A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yq�UATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOHK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �2 � OO1 � 1. OO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OFi CANCEL THE pERMIT FEE SAC CMARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON- $74.75 Fire SC �L.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
$77.75
SiG ATUR oFCON� �CTO oAn 12EDAGENT iDAiEi FIEN PROPERLY LIDATED THIS IS Y�R�MIT
_ �� , �� o � �f�
A RE OF OWNEQ iIF OWNER BUILDERI IDATEI ' BL G 4S� pt,TE —
rrEw
ADDN
ALTER
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ConstructionAddress :
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
� �°c��U a � `�� .
Effective 1/1/98
��� �
-�,-
� a� �L
Legal Description: I _
Owner Name & Address: ���, ���, , �� u� ��_ a.,, C��pau�2 . Tel. # � �� - `-f.� � S �
Contractor. � ( �-F - MN LICENSE #
Address: Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawa on it to scale. �
�
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
.�
� . � �_ �
� � �����
Construction Type; `f�� �?a , � Estimated Cost: `� �=�,� ��� � ��
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE; �P / APPLICANT:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
S�TIPULATIONS:
� � ���,
$ �. b 6
$ /� ��
$
$
$
$
$
$
$ r� � �� �
�� i �
Tel. #
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/1(3th%)
$.50/$1,000 Valuation
$1(�0 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 [ ] Not Necessary [ ]
;sr'.,;i3t!t
�ij:., �.',N'
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
$i to $Sq0
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$5�,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 additiona.l $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,(�0
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$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 $100,000 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, Q00 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)
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 construction 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.
;(�'� _
� 'J
�S ,�
�°`i�.
Y�."a.
CITYOF
FRI DLEY
FR[DLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
May 9, 1994
Oliver Tam and Chun Lai
7513 Central Avenue N.E.
Fridley, MN 55432
RE: First Notice of Noncompliance at 7513 Central Avenue N.E.
Dear Property Owners:
The City of Fridley has established a City Code for the purpose of
promoting a pleasant and attractive suburban environment. A recent
inspection of the property at 7513 Central Avenue N.E. revealed
that not all Code requirements are presently being met. Listed
below are items which does not comply with the City Code:
1. Fridley City Code requires that all vehicles stored outside
must be currently licensed and street operable. I observed
a vehicle (CCV538) located on your driveway which does not
fully meet these requirements.
2. Discontinue outside storage of a refrigerator and assorted
materials located in and adjacent to your driveway area.
Your prompt attention in correcting this situation would greatly
assist us in helping make Fridley a better place to live. An
inspection will be conducted on or about May 23, 1994, to determine
compliance.
If you have questions or would like to discuss this, please contact
me at 572-3595. Thank you for your cooperation!
Sincerely,
' II
Steven Barg �
Code Enforcement Officer
SB:ls
CE-94-182
�
_
C� ! I OF
FR[ DLEY
FRIDLEY MUNICIPAL CENTER • 6-�31 UN[VERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
May 23, 1994
Oliver Tam and Chun Lai
7513 Central Avenue N.E.
Fridley, MN 55432
RE: Final Notice of Noncompliance of the Fridley City Code at
7513 Central Avenue N.E.
Dear Property Owners:
On May 23, 1994, a second inspection of the property at 7513
Central Avenue N.E. confirmed that the following items still do
not comply caith City Code:
1. Fridley City Code requires that all vehicles stored outside
must be currently licensed and street operable. I obserued
a vehicle (CCV538) located on your driveway which does not
fully meet these requirements.
2. Discontinue outside starage of a refrigerator, furniture, and
assorted materials located in and adjacent to your driveway
area.
-A final inspection to determine eompliance will be conducted on or
about June 6, 1994. You should arrange to complete an approved
plan for compliance before that date. Should this inspeetion
confirm that this deficiency still exists, legal action will be
approved. If corrective action cannot be completed by this time,
contact me to coordinate a schedule to complete this requirement.
If you have any questions regarding this matter, please contact me
at the Fridley Municipal Center, 572-3595.
Sincerely,
Steven Barg
Code Enforcement Officer
SB:ls
CE-94-217
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FR[DLEY MUNICIPAL CENTER • 6431 UNIVERS(TY AVE. N.E. FRIDLEY, MN 55432 •(6l?) 571-3450 • FAX (612) 571-1287
June 20, 1995
Oliver Tam and Chun Sau
7513 Central Avenue N.E.
Fridley, 14Il�T 55432
RE: First Notice of Noncompliance at 7513 Central Avenue N.E.
Dear Property Owners:
The City of Fridley has established a City Code for the purpose of
promoting a pleasant and attractive suburban environment. A recent
inspection of the property at 7513 Central Avenue N.E. revealed
that not all Code requirements are presently being met. Listed
below are items which do not comply with the City Code:
1. Fridley City Code requires that all vehicles must be currently
licensed/street operable and kept on a hard surface parking
area if they are stored outside. I observed a Corvette,
License NNB 562 that is not currently licensed.
2. Discontinue outside storage of several bleach containers, jug
of oil, a screen, scrap metal, tire, pails and numerous other
materials lcoated in the driveway and entryway area.
Your prompt attention in correcting this situation would greatly
assist us in helping make Fridley a better place to live. An
inspection will be conducted on or shortly after July 1, 1995, to
determine compliance.
If you have questions or would like to discuss this, please contact
me at 572-3595. Thank you for your cooperation!
Sincerely,
�i�/'�j � l
/�,t(,
Kurt Schneider
Code Enforcement Officer
KS:da
CE-95-141
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FR(DLEY
FRIDLEY MUNIC[PAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55-13? •(6 1 21 57 1-3450 • FAX (612) 571-1287
August 23, 1996
Oliver Tam
7513 Centrat Avenue N.E.
Fridley, MN 55432
RE: First Notice of Noncompliance at 7513 Central Avenue
Dear Mr. Tam:
The City of Fridley has established a City Code for the purpose of promoting a pleasant
and attrac�ive suburban environment. A recent inspection of the property at 7513 Central
Avenue revealed that not all Code requiremer�ts are presently being met. Listed below are
items w�hich do not comply with the City Code: .
1. Discontinue outside storage of numerous miscellaneous msterials including crates,
carpet remnants, car battery, and car parts located in the drive area in front of the
garage.
Your prompt attention in correcting this situation would greatly assist us in helping make
Fridley a better place to live. An inspection will be conducted on or shortly after
September 6, 1996, to determine compliance.
If you have questions or would like to discuss this violation, please contact me at 572-
3595. Thank you for your cooperation!
Sincerely,
Kurt Jensen-Schneider
Code Enforcement Officer
KJS:Is
C E-96-301
�
sue�ecr PERMIT NO.
City of Fridley � 120'73
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV. � �
r � L � PROTECTIVE INSPECTION SEC. �j j%
1 = �
� /��'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�•---� � •'� 612-580-3450 910-F15 � �
�-�a-�.3
JOB ADDRESS 7513 Central Avenue N.E:
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. �6 3 Don's Sgh Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Glen Won 7513 Central Avenue
3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO.
Lee-Do Construction 7837 Madison St.N:E: 784-8629
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Dwelliag
7 CLASS OF WORK
�7 NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
uct flouse and ara e
9 CHANGE OF USE FROM TO
STIPULATIONS
See walkout elevation 24" above catch basin in rear yard
Provide verification survey
Provide Sard surface drive
Sewer Locat3on 124' N. of M:H. (N. Iav. 882.08) Wye Elevation 882.58 (Plugged)
Top of footing 885.58 (Mi�.imum)
Water Location - Must be tapped
6" C.L:P. 90' W. �f E� of Central Avenue.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOC�. fraIIL2
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION I. STALLS GARAGES 1.
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $ZZ � g%�J .O2 10.99
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEHMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING con,- ' S3 .00 L7S .00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
�a PLAN CHECKFEE TOTALFEE
����c,�,_ (�. $338.99 �
ssi ATUREOFCO�ACTO RuAUTHORIZEDAGENT IDATE) PROPERLY VALIDA ED THIS IS_YOUR PERMIT
�-� �i���,t/ � � � .;-.
SIGNATURE OP OWNER IIF WNER BUILDERI IDATEI