P - 35481�
Building PLUMBING Permit No.:
Inspections - RESIDENTIAL APPLICATION Received By:�
763-572-3604 CITY OF FRIDLEY ��� �� �' �- � ��
DATE�� Irl; J I�� Y�UR E-MAIL ADDRESS •
SITEADDRESS ���� �..a ��,�.�.,✓ NancyRedmond
THIS APPLICANT IS: ❑ OWNER �ONTRACTOR 7408 Concerto Curve
PROPERTY N�; Fridley, MN 55432
�W�� aDDxESS: 7637863417 rA� z�
TENANT
� PHONE:
CONTRACTOR N,�:
SUBMIT A CQPY OF STATE LICENSE #_ .Sb, EXP DATE
YOUR STATE ADDRESS• � t,rt� CITY i' ! IS STATE��LIP S�SY
LICENSE WITH , pHONE 7- Y03 FAX -
APPLICATION - '
PERMIT TYPE �SINGLE FAMILY ❑ TWO FAMILY - � TOWNHOUSE
TYPE OF WORK: � �W ��PLACEMENT
DETAILED DESCRIPTION OF WORK
� PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00; whichever is greater, for the
�: improvement, installation or replacement of a residential fixture, excluding the fixtures. (This.shouldreflect only.the cost of labor )
Labor cost under S300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
.: '�.ROR:��'ROJEETS WE�RE L,4BOR EXCEEDS°$3UO;�EES ARE BASED ON $10.00 PER FIXTURE,�EXCEPT:�iiE1�E Ni:2'1�DF:R[�'F�S: .(INDIC�.TE TOTAL
NUMBER OF EACH BEIAV� �
_ - --
BATH SWK/LAV - - - . . - FLOOR DRAINS . . - SHOWER WATER PIPING - - -
BATHTLIB GAS PIPING M�nc�rruc�ss) SWIMMING POOL WATER SOFTNER ($35)
CLATHES WASHER KITCHEN SINK WATER CLOSET � BACKFLOW PREV. ($15)
DISHWASHER =-LAUNDRY TRAY �WATER HP.ATER ($35) FOR IRRIGATION
_ WATER METER _ OTHER
Permit Fee $ Number of fixtures @$10.00 x$10,00 =$
Surchar e .50 Number of fixtures @$15.00 x$15':00 °$
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 UNTtL PROCESSED '
I hereby apply for a building pemut and I aclmowledge that the information above is complete and accurate; that the work will be in
conformatrce with the ordinances and codes 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 a permit and work is not to start without a permit; that the work vuill be in accordance with the
approved plan in the case 1 o w' r ires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME _ Je. NO/�b/DI�Y! DATE � L/�� `��
. Ciiy of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977