P - 36699Building
Inspections
763-572-3604
7fi3-502-4977 FAX
P' �7�IBTN�
RESIDEI�TTI�L �PPLIC�ITI+[�N
CIT�j �G1F FRIDLEY
Er=FCTi��•�: i-t-.o� t
Fermit No.
Received By: ' , "`T
�i�e��e� � � �
DATE 02/15/11 Ycat:°� e-N�.��L nr��RES� _wnelson larson lumbin .com
s�TE anDRESS 8071 Fairmont Cir
TH1S APPLiCANT tS� Ci f)W�'.Plt XICDNTRACTOR
ROPER'rY NamE: Beverl Shi shock
OWNEW
T�NAN�r ��RESS 8071 Fa�rmont Cirw ___„c1�� Fridley s-rarE Mt�k.�r�55432
rHOrrE: 763-786-0549
fson riumnma. inc
sun�ri' A COPY O� : STATE LICENSE �l 58757_ �„3341 PM EX�' DATE 12/31/11
YOUR 5"1'ATE
LIC}iNSIi. i30ND ANI) STA'TE B()ND #�w� ....._ �.._., __.�__. �._ _ � EXP DATE
ct:��r�ric�a•cE:or• `,�,Q��ss, 3095 162nd L.ane NW c�TY Andover s�ra��MN z�� 55304
INSURAiVCF PH[)NE 7fi3-427-7�80 FAx 763-427-9448 �
PERMIT TYPE
TYPE OF WQRK;
� SIivGLE FAPvSILlf
❑ NEW
❑ T6y'(} FA'4i1lti ❑ TOWh(HC}USE
l� REPLACEhfE1VT
DETAILED DESGRIPTION OF WORK Replace Water Heater
FEES ARE HASED ON $lO.Ob PER FIXTLIftE. EXCEPT WHERE NOTED. FIXTURES: (1NDICATE TQTAL NIJMBEit OF EACH BELOW). M[NIMIJM FEE
$35.50.
BATH StNKrLAV FLOOR DR�VNS SHOWER WATER P[P1NCi
6ATHTt1B �GAS PtPING (NEED CITY LIC) � SWIMMI1�FCi PO(?L N'ATER SOFTNER ($351
� CLOTH£5 WAS}iER � KE7'CHE2J S1NK WATER CLOSEf � BACKFLOW PREV. (� I 5)
_ D[SHVJAS}{ER _ LAUNQRY TRAY y1�ATER HEATER ($3� } FOR IRRIGATItJN
WATER METER OTHER
T}II5 IS AN �PPLICATI(�N f'OR A PERMIT-NQT VAL[D IINTIL PRUCLSSLD
I hereby apply for a pEumbing permit and I acknowledge that the information above is complete and accw•ate, that the wo��C will be in
conformance with the ordinances d codes of City of Fridtey and µrith the Minnesata Construction Codes; that 1 understand this is
not a peRnit but only an apgli • ti n for a perm' wor ' not tv start without a pennit nn site; that the work will be in accorcfance
with the approved plan in th o 1 w i q' review and approv of pl ns� .
SIGNATIJRE OF APPLICANT f1�NAME �i11j/ �NIC�S011 DATE O� I � J i�
APFRO�'AL INSPECTnRS 5I _ T1iRE �"') DATE _ �
City of Fridley
Building Inspections Department
b431 L;niversity Avenue NE, �'ridley, MN 55�32
7b3-572-360�
F�1X: 753-502-4977