P - 48333From: 612 822 5408 Page: 2/4 Date: 1/26I2012 5:04:01 PM
��c -#`�/a � .� � ��70�.� �o �#- d��o�"�
Building Y'Y,YTM�ING
Insp�ctior�s �����NTIAL AP�r,XC.A�,�'�al'�
753�5�2,3604 �I��r �� FRIDLEY
7G3-SQ2-4977 FA� EFFHCTIVE 1-1-2012
DATL � !� �j�'I
51TE A�DR .F.SS b �
1Z�IIS APPLICAlV1' IS:
FKUFERTY
� WNER/
TEIVANT
r �' YOUR N MAILADDIYESS
�,7� �- G.�. r+/�
� l7WN�R ,�COfV"CRAGTUR
=or
�
Permit No.: �'�", `��C �
Received $y:�
�C�sf:t ,, F ��! r� f � I
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CONTRACTOR nT.�E:_d.�'v�t}� .�dc�v�r�r7e�r,/��i_._�i���.v �� f3�i��....._.,�,.-
• Slp3MiT A COPY OF STATE LICL•NS� !F �C L/
�rouYt srn•r� �--.�-�^ � 7� 3 �xe nn�
iICENSE� �iOM} AND STATE F30Nll # E3CP DAT�
CERTIFICATE 0�' ADDRE55� �� �t' �
INSURANCE �},J - ���� � ... CiTY tNNeyf,�'GIt STATE�i✓�ZIP� �
PHaNE r��2� C� Q`I � LI ��� ....,. FAX
PERMITTYPE I%��n`'���rnMILY
TYPE OF WORK: I � ���''
❑'fwc) raMfi.Y p TDWIVIIOUS�
,P1�REPLAC�MGNT
ll�TAILLD DLSCRIPTION OF WORK ���.�1C
e
k'F.�S ARF. RASEA ON 510.00 PER PIXTURE, E?CC�P7' WHEAF. NpT�p, FIXTURES: (INDICA'I'� TOTAL NUMIIER OP �ACII D�LOW). MINIMUM PEE
S35,S0,
IIATII S[IQK/LAV ELOOR DRAINS $HC7W .F.R WAl"FsR PIF�ING
_ BATHTUR GAS PLPrNG (Nti�U CITY ),IC) SWIMi�IING POOL � WATGR SOP'INGR ($35)
_ CT,OTHFS WASHER Ki1'CH�N SttvK WA'IERCLOS�,T DACKPLOW PR�V. (315)
_ DISIIWASII�R _ LAUNDFY TRAY WA'I'�R H�,A'I'�R ($35) POf:1R12.[GAT10N
` �1'Ai'$R MFTBF _ pTHER
T[3IS f5 AN APPLICATION 1�ORA PERtvi[T-NOT VAi,[n UNTIL PROC�SSEn
I]Sereby apply for a plvmbixlg perrnit �nd Y Acknowledgo th the iiifonnation abave is cqmplete and accurate; that the work will be in
confarmance wzth tl�e ordin�nCes ancl eodes of thc City o ri ley artd with the Min��esota Construction Codes; that I uilderstat�d tl�is is
not a permit but only fln application ' e"t a� rk.i not to st�rt without � permit on site; th�t ttie work will be in accord�nee
with the approvnd plan in the case f ti lich • re review and appr of,plans. }
SIGNATURE OF APPLICANT P[ifNT NAME r� DnTE ` �Ca i
APPRDVA,LINSPECTORSSI TC1kf�: i� /0� neTn . _
' "C�ty af Fridley
uilding ��s�ections Department
6431 University �lvenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977