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P - 35445Buz�diung �nspecfi�ans 763-572-3604 7b3-SQ2..4977 FA� DATE` '� ) C2 � SITE ADDRESS f � Gi THIS APPLICANT iS: VWNER/ '��NANT coiv�r�c�rax SUBiVliT A COPY pF YOUR STA� LCC�TISE, BONI� AND CERT[FCCqTE OF rn�su�rrcE PER,IVXY'� TYpE TYPE OF WOxiK: From: unknown Page: 2/3 Date: 5/16l2011 10:29:31 AM �'i�UM�ING Per�xfi Na.: RESIDETI7TIAT. ,Al'PY,�CA�''XQN Recezved By: �ITY UF FI�DLE,Y" z����• � 6FFEC'CIVE 1-1-2011 YpUR E-MAIL A1�D1iE5S __.t� d."�' 1 4 0.G� 0.�S O N'�"S 1^ry� Io„ v� ba � Coy :hri s+� at, S oe� �.Y"t � O OWNER i�CQNXRACTOR ADDRESS: 5"Q C�1'ry''S�{-i '� SO �-1'�" Cl" PHONL: �,I, S, S' S' ` �„S � � NAM�:�C�G_�Mw.tiS dP� "�'�1Yw[, PI��"ni��i�� STA.�'E LICENSE # C? (q (� �, �'-- STA7E BONi7 # _ C�. � �'v. 0 S �D � � �2 iP E�SING4� 8AMlLY ❑ NEW DE'I'AILSD DESCRIP�'IQIV OF'WtJRK ���c�d' iuM,.b�2Y' ❑ �'WO FAMII,X I�REPLACEM�NT � A7� hLA7ZIP S`S"�� � a�-er }} �c�.�rs� L,1� EXP AATE I'� I 3�) 2,0 t� �__ E7Cp pATE � Z �+ f � Z Q( 1 rv cs�.. �o r� srRr� M'ni zip $5 �� FAx G23 -���-'? --4- v o � !7 TOWNFtQUSE �a� FEES ARE $,n,S�p ON 510.00 PER Ft7�Tt,►�E, EXC�PT WHERE NQTED. F1XTUlt�S; (3NDiCA7E TOTAL NUMBER OF EaCH BELOW). r�ir�lhfUM FEE S35.S0. _ BnrH StNKn.,4v ^p�,pOR ax.atNS _ SHOWER _ wATER PiFi13G �- �"T�TUB „_ GAS P1PfNG {NEED C1TY L1C) � SWIMMING FOpL ` wATER SOFTNER (S35) _ CLOTHES WAS�iER ��CITCHEN S1iVK WA,TER CLOS�T ��ACKFLOW I�tEV. (S15} _ DISHWA,SHER , L,AUMDRY T(tAY �WA,TEft HEAT$R (E3 � kiiII�lB�':....; af '� .�es � ` ���1 . �� � .. �7 ' � � e..: � � WA'�F„�t METER � �� �RRIGATI{3N — _ ��R . ..... :. �: :.::: .: . . . ..:� . • _:, , • .: ,.. •.. ., . • � .. • � • .�. „ -��:..: -.. ,.... • • . ...:..:.:v:. : . .,,.. .. ;^.,. . ; :., ••.,•., .;�::; ,r:' ::r:: ::,•• - ;:', .;: .. . . . ..... .. � � ,.ri , •.; :': •.; v.{:;K .. '-::7K'$:�}.0:�0-=, . ..;, .;.:.. . .. ....:�•: ,�'��� .• . ..:. � . . .. <::;.. �� . . ..,.. . . � . . .:-,.;, _ .,., .-_�:. ,: .:,:. ...,.;�. -.-=_.:. ..:. : �... . ,'. . �yvrv. ' •' .�: � .�.. . . . ..�; ..�.. ... , .�'�. ;•Y:i' :;T:::.r„ 'y.�;:2:." ,... .�i^. ...�b:�. �.: ..�.. .:n:.� ,ey': ��:. . 1� -.._....•:�.' ;::�::•.. ....r . �... •. : �:.. .°S:•`", ''?i",''•• :::j�- _ �,5::.,.`�;?' - • ��i�:a�� . ..:._ � :: �.: �: ,. ...... .:.:.::. ... .:::.... ... . ��,.. .� . . ::... .. : . ,;. •-•.r: �.;�•:::: •�..;,_>.. �� ....... .- :.:-�.� .:r,;:. ...;':i� • J:i; . "'� ..-• .�. .. • ,. .. :..... ..:. .� .. . . .:..: .. ....: .?r.:�� :.•.:.;;:: .' - • '"x''" ;:y• ' +. ;y�•' "� !`i��h�:� ;i'�.': • • :e,.���'..� r.;::;:: ' "' � .. . ; . � ' f V � �4 ::i::.A,.: .`;�i•• � M.•:)!.� ::1::�',:,�. .• 7�•:�. � .. M . •.: � "': ��' '.'-:S:_ . , .,.o .V•�:. ' ,�, ... � `:Yr:: r �;', _ :..��".�5:� �:$:' .�;.5� . ,. ..•:..... � ... :;,;. : ':..,.• .. .. . . . .. .. . ::.? . :• ...;: . ..� ..: :.. ... ,:... <::a'� ... ;t . • .:::r:�::.. . . . . , , . ,-��..�� .. � .. : . • . c' .. . ,. , 1/ +i- .... ..:�.� .,..�,:�.••.�. �.... . .i" ;:n.� . �.. ... . .,� ....:�' :.::`•:.. ::.i�•• . ..��" ... �lnt :�4�:' : _..�n • ..s..w.�. rv .....�. �.�� ,;.�1!'.'.. - .tW���•�s� �1� ...<.. ..:..� .:, ... , , ..... :.�.: � .::: �:� . :. :: .. . . . :1 •: ' � .. .. _ ,. .. .. . . , , . . . .. � ...:: .. ...�,•, :� :.... � . '��•��...'..5:00:::_:: ..., ..., .:p;.. .,, V. . .. _' � ' - - .. ,.,. . :'�-`- . .:. . ...: . �.:�: ...,:.: � , �. �: �.� , .. . . ,. :;, ; . .. . .... ....,, � , .. ,... �...... . :�.;. ; w•. : ...; -,�,,,;. _ .: ... . . ,. :; ... � �: �:.�: ���,;.... � - �.,. .:;..: , .. . 4 � -. .,, . Q " . .' .:. : .:.. .. . �.�: �. • •� . . _ :<. , . . , . ... .:. .... ....... ..::.: : . :•.,:..�.:'�' tal =�$ •!�' .. r...:. . , . ,. s'` . . .... . .. .... . ....:...���� .a. ,,. . :.;��,..�° :>4.:': ���.;:' ' •��s' • "•'�• `�. � � .. .... . _ . .: •. .:,.,- •. , , ., . . .. .:•. . �• :..... .. ....: � . ..'...'. • : . ... TEitS iS AN APPLICqTiON FQR A PERM►�'.NOT VAI.�D UN'f'1L PROCESSED T hereby apply for a plumbi»g permi� and I acknvwledge that the inforrnation abova is camplete $nd acourate; that the work witl be in conformance with the ordinarnees and cades e City of Fridley and with the Mi�nesota Canstruction Codes; tha�t I understand this is �at a p�amit but oaly art application for i and work is not Ca start without a pemnxt on site; that the wor[c will be in accordance with khe approved pian in� the e of al! r h r+equires revitw and approval of pta�.s�. Si43NA?URE OF APPLICANT f � IC�Mt`a� S� tft I( A.P�itO'VAk, IN3pEC'�pRS 3IG1vATU� pR7NT NAM� '� k DATE .. `'FT,EASE:N�r.'��•e��.�rio�uvnx:r . •. r .. . DATE - City o� Fridley Bu�ldin,g Inspections Depa�rtment 6431 University E1,vez�ue NE, Fri�1l.ey, NIl'� 55432 763-572-36Q4 FA�: 763-502-4977 �