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P - 59358i sl.� ��1..�IaC7" � . � . �..�1� 1�'1�.��� ��: � . i BAIi111! ���i... i :.e.��"''�,.n.���.�y�� � ,�L:�,�l 14 �x.r[-�� �f T _.i. ����i`.� ��-tr`..����cl j t<�� I �. �,. �r� _ � �,' ' -��**r-, - -- �-,—�r �-1*' � f����LJTp��''"M;• �� , . .,.-. t...i � �y F^-. �,- � i i . ��. � . :�u�..•!{..0 lY��� JL_ � -/-= = � �=?=r.,..r�tir. _.iL ! UATii � J'��/� YOUI: i-�b1FtIL F,llDI:ES`_, SIT�?_llDR'�SS % i0 � �'� C�f'�1o'�Gtr� C��iC. � TI-I15,4PPLICATIT[.�5: ❑O��iJEI: �Oi�JTI:���:TOi� �I�C1 L''�,a� ..,.,�r �w��� 'Y' :T�IFs.N?' �u�,N'�'�".�C i �R sur�Mrr ;� co�v or- YOUI: STATG LIC�NSL'-, 130ND AND C�RTIPTCATL OI' WSURf1NC� PETiiMIT �`YP�+ TYPE OF WORK: i�f���z �-��n ar � ur,L►,� m �� annr.LSS 1 Ca ! H-���mctn C�cr (• r1'rY ����(�-► s�rnTr ►�ilr SSY.�1 P HON G: �� ��'� a-� O- 3`f5 / .�+ � 1. . � . NAMl: � 1 STATL LICL-NSG R LXP DAT� STnTT; T�nNp � _ L'XP DATL ADDR�SS: S�(�%LI {'�'Y,�r�i S� �.�% czT.� ���,� (..e, PHON C`7G 3-'15`/- a� 9 9 r�h '76 3_ G�INGL� FAnRIL�' ❑ N�W DETAILED DESCRIPTION OF WORK ❑ TWO �AMILY ❑ REPLAC�MENT ❑ TOWNHOUSE eJ e� a�r� n�✓1 zir �sy3a FEES A£.E BASED ON $] 0'.00 PER PIXTURE, EYCEPT WHER� NOTED. PIYNR�S: (INDICATE TOTAL NUMBER,OF EACH BELOW); MINIMUivI FEE �35.�0. BATH SINK/LAV _FLOOR DRAINS SHOWER _ WATER PIPING BATHTUB GASPIPING(NEEDCITYLIC) SWIMNIINGPOOL WATERSOFTNER($35) CLOTHES WASHER KITCHEN SINK WATEP. CLOSET � BACKFLO W PP.EV. ($] 5) DISHWASHER LAUNDRY TRAY _WATLR HEATLR ($35) FOR IRRIGATION — WATER MET�R _ OTHER Number of.f�tures.�„a� $�S:':00 � x $35>00 $,:��� State�Sureharga; � � 5.0.0`,:� (1VSIMMi7M $'4Q.00) Total = $ ' , ' _ "fI�]IS 1S AN APPLIG�1"ION PO1:A PLRMIT-NOT VALID UNTIL PROCL'SSL-D 1 herebv appt�� Por a plumbin« permie and 1 ac!<nowled�ae that the information above is complete and accurate; that the worl: �vill be in eonformance ��.vith Yhe ordin�mces m�d codes oi'tl�e Ciry o�PPr� iley uud �.�itl� iJ�e Ivlii�nesota Consn•uction Cudes; th�rt I underst�nd this is �lot a ��ermit� bu[ only an application for ,:i ���ermit <u woric i� not to st�<ut withoui a pennit on site; that tlie avorl: �.vill i_�e ii� �iccorclanc� �;vith tl�c.. ai�pr��ved i�lui in th° �. e��i ,.ill � ri: •.vllich ren ires •evie�v �ncl •�in��roval ri �lans. �;ic����a���r.i.��i ��i>��i�c=,ri�r !�r:in�r��� �n.- ���iS jQ��� r_>n�e � —/2-- ,.n� ��«��_�.�, r�sa�s�,�� ��wz55� � i�'¢'�li�� - -- �''''��- �-- '� _ ...1. �(;?'�, .��F�;� .(' .. ��r. _.'"=:[ ., , I�.! � _'�;(' ;l_;,?L.:1� I:..i. ��C'� " ' •,I.. �i..� ',IL .i° ti(;f...,• -- ����� . . � . "1t1:;��� . Ixkilli��::l LP4 �:�1� :.J��.,.�Qa�}�xv _:J���'^';;,,'yl'.,--...¶I.�;�i. .� � ��IL i�l. '�ll".� ' . :��L�.: � � =.. . 1�.'.' , 11 .� _. _ _._ lb�-� r _--;i)l;_; � , ,1_. , ,_-�U_ _Q ��