P - 48571� „ •
Building ��,�T1����T�
Inspections ������T'g'���{, ��������'��leT
763-572-3604 ���� �� ������
763-502-4�977 FAX RFFF.CTIVE7-1-2010
DATE I� 1� 1 Z YOUR
SITE ADDRESS i�
THIS APPLICANT IS: ❑ OWNER L�CONTRA
PROPERTY NAME: �(
OiTVNEg2/ ADDxESS: �(� �Ifb��
TEI�IAIVT r � —� � ni ���./
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Permit No. �17i �
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Received By: �,
Date l���i � ,,,_ � �� � �.
A
CONTR�.C�'OR Nn�,,¢ vnamp�Ur, r �ue ��y„ ,�
SUBMIT A COPY OF STATE LICENSE # EXP DATE � v- I� 1 i
YOUR STATE -
LICENSE, BOIQD AND STATE BONL # .�c�n rle�� � EAP DATE
CERTIFICATE OF ,�n�ss: �agan, MN 55123 CITY STATE ZIP
INSURANCE PH�� FAX
PER1V&YT TYPE
II TYPE OF �i'ORK: I � ��'
FAIvIIIJY ❑ TWO FAMILY ❑ TOWNHOUSE
DETAILED DESCRIPTION OF WORK
�1tEPLACEMENT
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMLTM FEE
$35.50.
BATHSINK/I.AV _FLOORDRAINS SHOWER _WATERPIPING
BATHNB GAS PIPING (NEED CITY LIC) SWII��1G POOL WATER SOFTNER ($35)
CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($1�)
DISHWASHER LAUNDRY TRAY �WATER HEATER ($35) FOR IRRIGATION
— WATER METER _ OTHER
(1vu1V11vYU1vl a4o.w/ r; t u�ai -,D :- tv ^-*���
` THIS IS AN APPLICATION` �OR
I hereby apply for a plumbing permit and I acknowled'ge tha3
conformance with the ordinances and codes of the City of Fri
not a permit but only an application for a permit and work is
with the approved plan in the case o 1� work whic e'
SIGNATURE OF APPLICANT
APPROVAL INSPECTORS SIGNAT
:` FLEASE NOTE:. 'SEFfi PERMITS'ARE REQ R
�
A PERMIT-NOT VALID LTNTIL PROCESSED
the infoimation above is complete and accurate; that the work will be in
i�and with tl�e Minnesota Construction Codes; that I understand this is
not o start w�hout a permit on site; that the work will be in accordance
�u�l��ectgons Deparime�t
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
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