AF - 45901,�
,:-
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nace: a� 1�, 1965
. � � 1' :
�r:n;
City of Fridley, Minn.
BUILDING PERMIT
:1` . .�, � p..�, : .
Iq i �
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N° 8194
Addreas �+27 �'9 �eaus �lcrth .._.._ aadreas �27 I+cvey Avetme Nort�h _,_
M3nne olis 11 �4lnnesota idinnsapolis 11, Minueaota
LOCATION OF BUILDING
xa �Z4_ s+�eec —�xcc�� sr. ___... r�c ot �c ----
I,,t 37-38-39– �—i ----_. naainm or s„�-ni.�si� Biverriew Hei�ta
Corn�.n' Lot ---.— Inside I.ot Y Setbsck —��._—.._. sideyard �' Yt. ___
Sewer Elevatlm ��---- — Fo�mdaUon Elevation -------- —._..r.
DESCRIPTION OF BUILDING
To be Uaed as:
lkts173s�¢ Frmt � nepth --?? xeisht 20 sa. F't. l� Gw. Ft 21�200
� Firo�t neptn __� 8etg6t sq. Ft. —, Cu. F't
1Y'Pe of Ca�ah�uctlon Fi'�i Fst Coat ���•0� .... To be Completed _...--.--.-
�-Y. ` �' � �
Ia Cooslderatlon of the lseuance to me � a permit to caost
th8 y�opo�ed work ln accordeace wlth the dEecriPtlon a6ove net
aa'dinanoes aS the dty oP EYidiey.
l above I agree to d0
wiffi a51 provSaions ot
In amdderaHan of tLe paymeat of a fee � E–��—, P�t ia h�ebY 6r8nted *o ;PB�D G�. �
to canarivet t6e bufldln8 or addition es described above. Thiepermi t is'�anted upon
the expreas oondittaa that the Persoa to whom 1t is ganted and his aBenb. employees and worl�en, ffi ell work
�done fn.� around and up� aeid building, or aRY thernof, ahall coffionn ia all respects to the ordinancee a�
F�1d1eY. Minoemts regardfn� locattao, ca�stru�alterattm, matnt�aace. rnP�' a� IDwinB oP buildin8e
wl� dty limiffi and iha permit mR9 6e revoked at any tlme uP� violarion oP aqy o! the Broviaiaoa o� said
.C�,� Ci, ):
���
TW PweY dea w! cswr 1M swmeeMm. YWallYise /sr `rYiY. P�W M� �W aiwr a wala. N an ro aM
W� MidW IrpMer far ap� P�6s fa fY�w Ynu. � .
..r:>-
OWNSR'S N�
APPLICATION FOR BUILDING PERMIT
�- --CITY OF FRITR,EY. MSNNESOTA' �_
ADDRESS ADDRES
NO
LO'
OF BIIiLDiNG
CORNER LOT INSIDE LOT ��&TBACK 3 S�� SIDE-YARD�� /� i�
SEWER ELEVATION FOUNDATION SLEVATION
Applicant attach to this form Two Certific&tes of Survey of Lot and proposed
buiLding location drawn on these Certificates.
DESCRIPTIOA.OF BUII.DING
�
Sq. Ft. �/J /o [J Cv, Ft.3��y��
Frpnt Depth Height
Sq. Ft. Cu. F
�,� b�'
Type of Conetruction G,�r��iLiyL_Q Estimated Co t
To be completed
The uadersigned hereby makea application fox a permit far the work herein
specified, agreeing to do a11 s+ork in strict accordance with the City of
Fridley Ordinancea and rulings of the Department of Buildinga, and hereby
declares that all the facts and representations stated in this application
are true and correct,
,--
DATE '�' "^' �SIGI3ATIIRF,
(Schedule of Fee Costa can be found on the Reverse Side).
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wi�h r�fexesace �� ±h� heax+ 1�saze� aE 374 Glea�eoe 6t�eet (Lats 37-
a�d 38, �&oc3. i, �iveAVi�a I{eighCs ?,���.ti�n) ws ��fer i:ii� falios,_
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P.ngS.�eee.fi.n$ �s�iste�st
City of Fridley, Minn.
BUILDING PERNIIT
��; October 30, T1970 �
�
S 3%-�
° 108
p�; I,eRoy A. Marguette B�r Sussel Gaxa�e_._&_Owner..,_.._..._.._____.__
A�,� 574_Glencoe Street A.S. _.._ Addiees — —..--_._..__.._..._._._...--.-
� LOCATION OF BUILDING
''. No, 574_.._.__.. 3treet . Glencoe Street N.S. —.—.-_ ----_-._ Part oi Lot --
Lot 39 _�__..._ Block ._.. I.--..--.--..._._ Additlon or Sub•Diviaian ._�verview Heiphts—`---
Corner Lot ------- Inaide Lot ._.._._X ..._.._.._._ Setback - ---- Sideyard :
3ewer ElevaUom -----.--..--.----._ Fwmdatlon Elevation ...._._--
DESCRIPTION OF BUILDING
To be Used aa:
5�..�aSe — F�ont ?�� ._ Depth -.24.�._.._. Height 10� _ Sq. Ft _528 _ Cu. Ft 5280.--
_ F�ont --..__ DePth ---'--._ Hdg6t .—__ Sq. Ft. —_-'— Cn. bY. _.__--
7ype of Constructt� _..Frame._.._..� Fat Cost _a�2300.------.._.... To be Completed _ S.EFi�z_of 1971
Maintain minimum 18" elevation over street grade.
Provide hardsurface driveway.
In twnsideration of the issuance to me of a perm{t to construM t6e building described above, I agree to do
the psopoeed work in accordance with the deacritPtloa above aet forth and in compliance wiffi all P�ons of
Iwvlinfnnae � fMn iA�v nP L4�iila.r
Ea caodaerattm at the paymeat of a fee d S.LS1.9�—_., permit ts ha�eby grantea to�a?�9y A
Marquette to c�struct the building or addition as dencrlbed above. Thisp�� t is Srenbed upaa
the exPrnas oonditlon thet thepe rson to whom it is gi�anted and�hia eganta, emPloY�s and worlanen. in all work
��� �a�adreupao�dntnsaaid b��, � a����. alteration, maintenance, repairs� Mo �o��ulldinoasf
wl� dty limiffi and tLis P�'�t �Y be �ro�Ced at aqy time up� vialatlon of any of t6e BT�vlaions of said
i��.C.�L �L2�� �! guiidin8 IasDectac
MQTICic
�. fYY: �w�M Ar �.�e eewr fM �o..�rueRey iMdlui.. tw WYiaf. �i�6Y�, f�s h�p. aw�r a vNV. N yun b s.�
N� MIWiy- 4q�fer fer nP�rM'� P� fer IMw NNn. � .
� �
fi ' t _
APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADllITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
) M SussE� �r+�rt�E' �
OWNER'S NAME:_ l�� �8`� A•,-/FfII{�7U�i 'FLD&R: OCVil1G�
T
nnnx�.ss: S�Y�G�l�niem� �ic/�nn�ss:
NO:, S�I ' STREET: GLEN�%O� S' % Jt�G'•
LOT:�BLOCK: ,y ADDITION: _ �7A-Q,t �'{ �
CORNER LOT: INSIDE LOT:� SETBACK:_ � _SIDEYARD;
Applicant attach to thia form 7tao Certificates of Survev of Lot and proposed
building location drawn on theae Certificates.
HESCRIPTION OF BUILDING
To Be Used As:
G�Q��� Front: .�i�� Depth; v?T � Height• l�
�
Square Feet• J� �� Cubic Feet:�aj1� �
Front• Depth• Height•
Square Feet; Cubic Feet•
Type of Construction:
�^ �r�-��� � wO�Estimsted Cost:_�
To Be Campleted• ��si��M.vX�' � �/�9�/ �3ao
Q
The underaigned hereby makes application for a permit for the work herein
apecified, agreeing to do all work in sttict accordance with the City of
Fridley Ordinancee and rulinga of the Department of Buildinge, and hereby
declaree that all the facts and representatione atated in this application
are true and correct.
L1ATE: _ !���c��!'// v SIGNATURE: �� �.X-r �l
(Sae Reverse Side For Additi�nfo �tmion.)
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CCI1rOE
FRIDLE,Y
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
August 22, 2000
CORRECTED NOTICE
Sandy Zacharias
574 Glencoe St NE
Fridley, MN 55432
Re: Final Inspection at 574 Glencoe St NE
Contractor: Blaine Htg. A/C Elect., Inc
Dear Ms. Zacharias:
A mechanical permit was issued on May 22, 2000 for the property located at
574 Glencoe St NE to replace a 6 inch liner with a 4 inch flue liner. According to
Section 305(a) of the 1991 Uniform Mechanical Code a final inspection shall be
performed on the mechanical system. As of this date no inspection has been
cafled for.
You will be given thirty (30) days from receipt of this notice to respond. If we do
not hear from you, we will expire the permit and any inspections on this
installation will require a new permit.
Any questions can be addressed to myself at (763) 572-3603.
Sincerely,
:NSEN
Inspector
City of Fridley
I.T TNf TOP OF (NE �W�NS
;�
� � ��� COMMUNITY DEYEIOPMENT OIY.
r � L PROTECTIVE INSPECTION SEC.
�
�L 1 /"'1 � CITY MALL FRIDLE`/ �S�J7 MuMlEA
L � � � 1
BUILDING PERM
"" ' 763-571-3450 910-F15
lOB ADDRESS 574 Giencoe Street NE
1 IEGAL �OT NO. BLOCK lRACi ON ADDITION
oesca. 37,38,39 I Riverview
2 PROPERiYOWNER MAILAODRES$
Sandy Zacharias 574 Glencoe Street NE
3 CONTRAC70H MAII ADORESS
Pat Boland Con�truction 3233 140 Ave N
ENGINEER
�Ev
DiiE vapF o�
6/26/03 / /
33645
T NO.
35�y
•VPPOVEO !�
SEEATTACHED
SMEEY
6 USE OF BUILDING
Residential
7 CLASSOF WORN
❑ NEW ❑ AODITION ❑ ALTERATION � REPA�H ❑ MOVE ❑ REMOVE
B DESCN�BE WORN
Reroo: Honse (15 Sq} Tear—off
9 CMANGE OF USE FROU TO .
S7IPULATIONS
Ur.deriayment nust comply with the State Buiiding Code.
SEGARATE PERMITS AFE NEOUIREO FOA EIECTRICAL, PLUMBING. MEA�ING.
VENTI�pTING OR Alq CON�ITIONING.
TMIS PERMIT BECOMES NUIL •ND VOID IF WORK OR CONSTRUCTION zONING
AUTMORIZEO IS NOT COMMENCEO WITNIN 80 OAYS. OR IF CONSTFUCT�ON
OR WORK I$ SUSPENDEO OR ABANOONED FOR A PERIO� OF 17(I O�VS A7
ANV TIME AFTEfi WOFK IS COMMENCEO. NO DWLG.
I HEAEBY CERTIFV TMA7 I HAVE READ AND E%AMINED THIS APPLIL�TION �
ANOKNOWTMESAMETOBETPUEANOCORRECT.�LIPRO��S10N50F�AW5 y��WTION
ANO ORDINANCE$ GOVEFNING TMIS TYPE OF WORK WII.� BE C�MP�IED
WITN WHETHER SPEQFIED HEpE1N OA NOT TME GAANTING OF A VERMIT �1 a]3�
DOES NOT P E TO GiVE AU7HOA�TV TO VIOLATE OA CANCEI THF pERM17FEE
PAO�151 Of V OTHER $TATE OR �OCAI LAW REGUTATING con- �63.15
6TfjUC ON�OR E PE/jiC�MANCE OF CONSTRULTION
iD�rE�
$TALLS
OCCUPANCV�OAD
Cll fT
GARAGES
�.8%
ACCMANGE
Fire SC $1.74
OT �FEE
$ 0.76 .
NEW
ADDN
ALTER
II
II
II
Construction Address:
Legal Description:
Owner Name 8 A�
Contractor:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
CITY OF FRIDLEY
Effective 1/1/2003
6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
'�7� ����� � -
1 S Tel. il
� MN LICENSE
ov��: #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width
Length Width
Height _
HgUGround
Sq. Ft.
Sq. Ft.
�3
v • �J,�
Construction Type: �� �°��%� Estimated Cost: $� /f��
Driveway Curb Cut Width Needed: ,_Ft. •t =_Ft x$ _$
DATE: �� APPLICANT: T I. # [� I� `
- S'p� _ ,rL4�
Call (763) 572-3604 for Pertnit Fees if mailing in application. Fax to 763-571-1287 if usi g c dit card and we wdi
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
$ ��J
$
$
$
$ �DO
$
Fee Schedute on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1275 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ J Not Necessary []
TOTAL $ ��� / F� STIPULATIONS:
Inspections
763-572-3604
763-502-4977 FAX
DATE�
S[TE ADDRESS E
7'HIS APPLICANT IS
�W�+N
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOURSTATE
LICENSE, BOND AND
CERTIFICATE OF
INSCiRANCE
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
❑ OWNER �GON7RAC'tUR
�45
Permit
Received
.. �:�; :y
Na,Ma: ertn �i / ' 1n G
STATE LICENS q / EXP DATE �2 � 3/ - �g .
STATE BOND p L PO U' ` S�9I EXP DATE /.2 ^ 3/ ^ OS �
,wDaFSS:,�5q03 6.� Sf NW CITY �IMrnPlmAn STATEH?N Z[P SS3%E
PHONE %IB3'" $S%^ �o%% FAX �%�.3 � S�S(s ' Cn%� /
PERMTT TYPE p�"��v�
TYPE OF WORK: � �N'
DE.TAILED DESCRIPTION OF
, . , , . r _ � i _ c
FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
�REPIACEMENT
f
PER MS 16B.665 the permit fee is a minimum of $15.60 or 5% of the total cost up to 5500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cos[ of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS = plus .50 surcharge
OR
FOR�PROJECTS WHERE LABOR EXCEEDS S500, FEES ARE BASED ON E70.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (1NDICATE TOTAL
NUMBER OF EACH BELON�. MINIMUM FEE SI5.50. �
� BATHSMK/LAV FLOORDRAINS SHOWER WATERPIPiNG
/ BATHTUB � � GAS PTPiNG (NEED CITY LIC) SWIMMMG POOL _ WATER SOFTNER ($35)
CLOTHES WASHER KITCHEN SMK �� WATER CIASET BACKFLOW PREV. ($IS)
DISHWASHER LAUNDRYTRAY WATERHEATER($35) FORfRRIGAT10N
— WATER METER OTHER
Permit Fee $
Surcharee .50
DUE
$15
Number of fixtures @ $10.00 � x $10.00 = $��j�
Number of fixtures @$ I S.DO _ x$ i 5.00 =$
OR Number of fixtures @$35.00 x$35.00 =$
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
State Surcharge =
mi<<m �r...,t-�
I hereby apply for a plumbing permit and I acknowledge that the information above is complete and acwrate; that the work will be in
conformance with the ordinances a codes of the Ciry of Ftidley and with tlie Minnesota Construction Codes; that 1 understand this is
not a permit but ly an applica' foi a it work is not to s[art without a permit on site; that the work will be in accordance
with the approved an in the of �I vires review and approval of plans.
� � C�rell
SIGNATURE OF APPLI T PRRJT NAME �:V � �� DATE S g
APPROVEDBY - DAT
City of Fridley
BuiIding Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building
Inspections
763-572-3604
763-502-4977 FAX
517E ADORESS J
THIS APPUCANT IS:
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOURSTATELICENSE
AND CERTIFICATE OF
INSIJRANCE
PERMIT TYPE
DESCR7BE WORRBEING
SIZE OF IMPROVEMENT
ROOFI�
NUMBEROFSQUARES
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECT[VE 1-t-09
YOOR E-MAIL
❑ Ok'NER � �ONT[2ACTOR
���v�����
��. •
STATE LICENSE #
�.SINGLE FAIvIILYMEW CONSTRUCTION
� TWO FAMILY/NEW CONSIRUCTIQN
❑ BASEMENT FIN[SH ❑ ROOF
❑ DECK �'SIDIN
HOMECONS7RUCTION
FAX
❑ ADDITION
❑ REMODELING �
❑ HOUSE ONLY
❑ HOUSE & GARAGE
GARAGES ❑ ATIACHEDGARAGE
PROPOSED SIZE: ❑ DETACHED GARAGE
PROPOSED HEIGFI'C�.
�Vinyl Soffit
❑ Aluminum �im
❑ Other �Pascia
/\
WINDOWS
INEXISTTNGOPENINGS OYes �NO LOCAi70NOFWMDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENMG CHANGES &
TYPE OF WINDOW TO BE RJSTALL6D N77MRFR (1F WiNi
ALL FEES ARE BASED ON VALUA
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
Total Due
OT�IE 1997 U.B.0 FEE SCHEDULE)
EXP
❑ DRAIN TILE
❑ OTHER
Permit No.:
Received By:
V1�!
ATE_ZIP
� S- 53L,
BASEMENT REMODELING SUBMIT:
1. Exis[ing Floor Plan
2. Roposed floor plan
3. List of shvctural members to be used
FOR NEW WNSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT�
l. Sire Plan/Survey showing the exfsting structuces
and proposed prqect.
2. Two sets of construction plans
3. Energy Celculations
AND MATERIALS:
� See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ .001 times the total job valuation
$ .0005 x Permit Valuation Minimum $.50
$ $5.00 (State Licensed Residential Contractors)
$ $2000 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= frx$21=$
$ $450 Conservation Flan Review
$ / Fee Determined by Engineering �
$ -7 1 1,/1 �% Agreement necessary O Non Necessary O
to: Citv of Fridtev Attach
THIS IS AN APPGCATION FOR A PERM[T-NOT VALID UNTIL PROCESSED
I hereby apply for a building permi[ arid I acknowledge that the information above. is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construc[ion Codes; that 1 understand this is not a
permit but only ao application for a permit and work is not to start without a permi[ on site; that [he work will be in accordance wi[h the
approved plan in the case of all work which requires review and approval of plaris. �
SIGNANRE OF APPLICANT
Building
Inspections
763-572-3604
763-502-4977 FAX
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
DATE 0-.� - O 7 YOUR E-MA1L ADDRESS
SITEADDRESS�' `S .�'I �� �I�L.�I CISL Sfc� N �
THIS APPLICANT IS:
PROPERTY
OWNERI
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOURSTATE
LICENSE WITH
APPLICATION
PERNIIT TYPE
❑OWNER �CONTRACTOR
63- 7Y3-"t4�
COMPANYNAME: CGt4�/
CONTACT PERSON: C� �r
STATE LICENSE #
<S
1
EXP
a
Permit No.:
Received By:
Date�:�
Ma
ADDRESS:da967"I0.�� SF U� CITY F��OIy� STATEN✓ZIPb��31
PHONE'763' `7 S�i' � � g 4 FAX
TYPE OF WORK: I� NEw
FAMILY ❑ TWO FAMILY
I3�REPLACEMENT
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK �xtSiY+ t� QQAI s.� e. tr� n i- Fi�c2v� n�� j- A� 2 C� ovin'�t I-t er�ti
FEES ARE BASED ON 510.00 PER.FIXTURE, EXCEPT WHERE NOTED. FIXTURES: ([NDICATE TOTAL NUMBER OF EACH BELOW)
Equipmentlnstailed F�,v/L MFG: YLvv10 MODEL: tJGR�-DI. �HAtS � SIZE/BTU LO �o 0
a C MFG: 12-V V A . MODEL: (,/9PH - Ody ,(A'i.- S13E/STU a���
� MFG: MODEL: � SIZE/BTU � � �
� A/C 525.00 . FIREPLACE (GAS) $15.00 � GAS RANGFJOVEN $10.00
_AIR TO AIR EXCHANGEER S15 FIREPLACE (WOOD) 535.00 �NE W GAS GRILL 510.00 .
_BOILER $35.OU �FURNACE S35.00 ^GAS UTi1T HTR�$10.00 �
CHIMNEY LINER 510.00 GAS DRYER 530.00 � POOL HEATER $35.00
�DUCTWORKE10.00 GASPIPINGEI0.00 � VENTILATOR$15.00
'PHIS 15 AN APPLICA'CION FOR A PERMIT-NOT VALID ISNSIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the Ciry of Fridley and with the Minnesota Construction Codes; that [ understand this is
not a pertnit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPWCANT C� ti c o � Fso-h PRINT NAME � C'I-. �e S �ciQ,�_DATE B- S' d 9
City of Fridley
Building Inspections Department
6431 University Avenue NE, Pridley, MN 55432
763-572-3604 FAX: 763->02-4977
Building
Inspections
763-572-3604
763-502-4977 FAX
'�5�1�
SITE ADDRESS y�
THIS APPLICANT IS:
OWNER/
TENANT
PHONE:
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 7-I-2010
❑ OWNER
SUBMIT A COPY OF STATE LICENSE #
YOURSTATE -
LICENSE, BOND AND STATE BOND N
CERT[FICATE OF ppDx�SS: �
INSURANCE pHONE
PERMTf TYPE C�'LE FAMILY
TYPE OF WORK: � ��'
DETAILED DESCRIPTION OF WORK
YOUR E-MAIL ADDRESS
❑ TWO FAMILY
�PLACEMENT
FAX
❑ TOWNHOUSE
Permit
Received B
Date �:
e3cP DA� { Z -3D—IO
FEES ARE BASED ON $10.00 PER FIXTURE XCEPT WHERE NOTED. FIXTORES: (INDICATE TOTAL NUMBER OF EACH BELAW). MINIMUM FEE
535.50.
BATHSINK/LAV IAORDRARJS SHOWER
BATHTUB GAS PIPING (NEED CITY LIC) SWIMMMG POOL
CLATf�S WASI-IER KITCHEN SINK WATER CLASET
_DISHWASHER _LAUNDRYTRAY WATERHEATER($35)
WATER METER
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
WATER PIPING
WAT"ER SOFTNER (S35)
BACKFLOW PREV. ($IS}
^ FOR IARIGATION
OTHER
I hereby apply for a plumbing permit and I admowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances aod codes oF the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an appl' n' n for a e't and work is not to start without a permit on site; that the work will be in accordance
with the approved plan in cas of al ork '� require�iew and approval of I s. ./ }�
SIGNATURE OF APPLICANT _ �PRINT NAME � �/%/YN -DATE /, IS � _ .
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977