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P - 46814N �; I .� ,� ;: a; ,� From: 612 822 5408 Page: 212 Date: 1173/2Q11 11:36:43 AM �•�� _ ,L + ' �i �. F � �` f�=` p L � �� l��''� -�-- '- ' �� . . � . . �3uildiz�� PL�U'11�3i�C� per�it�va,�' " e 7nspeetzons RE,�x��NT�A.� �'�'�,,I�A�'YU� �.tecei�ea �y:_ ��3-s�2-3�aa� CITY O�' F1��,EY R�� 763-502-4977 FAX � �� r.LVCr-rnrc � e�. en,� S1TE ADDRESS � fiH15 .�P'PLICANT IS: , �ROPEt�x� ow�� v,r�r � r..n� r6p rwl, .c.�(i�. �1OW1V�R �GONl'�tACI'OR ��,r.�_�.�..,. • , ��i °,��'''�� tn.�, �./ 7. �-1s/; e �c 3 SUBMIT A COPY OF �— — �YOttR STAr� sTnr� ucExsE � S� � �"'� _, EXP DATE x.7f:�7�ISL, $OND AND STATF �OND # 0 � EJCI' DATE �$RTIF7CATE �DF ' AbDRFu�S: � J' CTY'Y' �T rri'zl��<�J INSCJ'RANCE PHONE �n/2� 7� 5� q�-- -- FAx %�`z �' �3%' p�RNIlT TSCPE ! [[�'Sl�rGr E F�m�.Y 'X'i�'z'� OF WORJfC: � o rtEV'r nETAII.Ep D�scItmTTOI� oF wor�K O TWO FAMT.LY ❑ 'PpWN�t011SE �ItC,�LACE�ENT �-.z,��., k�S ARE BASED ON 510.40 PER Fb[TURE, EXC,�'T wRI�RE NOTLb. FDCfIJR.�S: (II�p�CATE TO'1'AT.Ni7tv��i OF EACH BELOV�. M�i�vlt,TM FEE �35�0. SA'fH SINK/LAY FLOOIi DRAINS ,_ SHOVUER VVATER FIPI'NG _ BATHTUB _ GAS FiP1NG {NF.I'dti GITY LIG) ,_ S WIl+�IlvIDVG POOL �„ WATER SOk"fI+TEIt (S35) �LOTfiES WASHER IZYTCF�N SINK WATEk CLdSET BACKFLOW PftEV. (S15) _At5FI1�7ASiTER _I.aUNURYTltA2' �WATER�ATEIt($35} � FORfitRtGATfON ,_ WAT�k IutETpR � oTHER T,f�IS I5 AN APF�.xCATION �OR A kERMIT-NOT VALID [JN'I'!t, PRqC$55'�D I heseby spply fo�' a plumbin�, pennit and � aCknowIedge that fhc informalion above xs complotc and aceurate; k1�at thC work will be i,�t confocmanco with thc ordinatices �and eodes of thc Gity of Fridlcy and with thc Miuutesota Const�uctioi� Codes; tbat Y undcrstand t}ai:s is not 8 permit but t)nIy an appliCatiQn fpr a p�t�nit and wprk is not tp St�tf withovt a pemut on sitc; tbat tF�e wotk wi11 be in ar.r.n�� weth tho approved glan in t�t� , a11 I� whi �quir�s rcview and appro fpIsns. � /1 SIGNAT[JRE OF APPLICAIV'T �� PRllVT NA1vIE �f6r.r.� �� _ DA7'� � ��r r .,,..,,,..... ,...,...,...,...,,......_........... �- _ -- �ll�'' o� �+I'li�l�y Btuldin,g Znsp�c�o�ns Depaztment b431 Univexsity Aven;ue NE, �'rid.�ey, MN 55�132 763-572-3604 FA�: 763-502�977