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AF - 46790� Date Owner Address BUILI)ING PERIVIIT Viliage of Fridley, l�I'Iinn. N° 2 3 5 5 ��:�. . . . . . . . . . . . . . . . . . . . . . . � ..... .f��• • • •f • .. .. .. . .. . .. . . . ... . . . . Builder ��.. ..•tsT._"v'".�.'e��f. . ..... ..... � � IiG�I _ � ��(' •yf�i� • • • •-• • . . . �� . . . . . . . . . . . . . . . . . . . . . . . . . .� . . . Address . .��. � 4. . !. :'� � . ,� LOCATION OF BUILDING ]`''� No. .(.�l.......... Street .�'.�.�'..�.'.".��t'�yi�"y.:•.�. . ........... Part of Lot .................... Lot . . . .�� . .. . . .. . Block . . �'.".`. . . . . . . . . . Addition or Sub-Division . . . .. . . . . . . .��. . . . . , , , , . , Corner Lot ............ Inside Lot ............ Setback ............ Sideyard .......................... DES�CRIPTION OF BU(LD�NG To be Used as: �. � �"�� f t r �.�.;'� ` 2! ` . � r ,,,° � . : � . . . . . . . . �. . . Front . . : . . . . . Depth . . .•.a. . . F?eight . . . . . . . . . Sq. Ft. . 4- ` `. . . Cu. Ft. . . . . . . . , , <� 5 �� . c :� r. . . . . . Front . . . . . Depth .t �.4 . . . . Heig'it . . . . . . Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . . i " . <•-: - YP rt €'l ` ��' `' �', �� . . . . . . . T e of Construction . .�. :'F . . . . � . . . . Est. Cost . ;?`: � . . . . . . . . . . . . . . . . . . To be Completed . . . . . . . . . . . . � �l �_...�..../ i � �� 3 � s i/ z .�---� � S-" =� � z � ' ._--------� .rf :� In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of Ordinances of the village of Fridley. j _„ ,` � \ -,. In consideration of the payment of a fee of $.�t? �'; permit is hereby ted to ....... ...... ...... ..... ...•. .. to construct the building or ad dition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and worl�nen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the village limits and this permit may be revoked at any time upon viola ' of any of the provisions of said ordinances. �, � �, .'�!..... Building Inspector NOTICE: This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. • � U City of Fridley, Minn. BUILDING PERMIT Feb. 1, 1968 Date: —.— N° Owner: � George Rusler ��, D. W. Harstad_^�__.� �,g� _.____� _169 Hartmau Circle_ A� M]101 I3i�hw,�y.� �yot�'�l 9606 LOCATION OF BUILDING No. —169 _ S�t �..._...Hartma� Circle _�.._.._......._..... Part of Lot Lot ._._..._..... 18 __ Block __._. 2....__......_._.._..._..— Addition or Sub-Division ....._.._._�17 h, a -- Corner Lot ____._..— Inside Lot Sewer Elevatia� Setback —__._---.....__.._._ Sideyard —.— Fwmdati� Elevation .-•-•---....._. DESCRIPTION OF BUILDING To be Used as: Bsmt . Remodel �t —. Depth � Height ' Sq. Ft. —..r..____.._____._._..— Front � DePth — IHeight ____ Sq. F't. _ Type of Construction _.._.. Frame _._._....__.. Fst Cost —_�3__000 _____._........ To be Completed Cu. F'w G�. FL In consideration of the issuance to me of a permit to construct the building described above, I agree to do the propoaed work in acoordance with the description above set forth d in com ' an�e th all pravisiona oi ordinanoes oi the dty of Fridley. �.6!/. � (=o �°e—' � /�ci � /� Lu.� ,—� In caosideration of the payment of a fee of � 18.00 ��t is hereby graated to D. W. Harstad to c�onstruct the building or addition as described above. This permit is granted upo� the express o�dition that the person to whom it is granted and lus agents, employees and workmen, in all work done in, around and upo� said building, or any part thereof, shall conform in all respects to the ordinances a� Fridley, Minnesota regarding location, construction, alterah , repair and mavin8 of buildin� within the dty limits and this permit may be revoked at aqy, '�e u�pon��q�va� Y of� A provisians of sa�d ordinancea r 1 � Official BuildinS�io�nt • NOTICE: —_ 1N� pwwil doa not eowr tb� �, hahllMke fer �ririN. P�W 0� �Y. sww�e or w�Nr. M wn 1e sN tM duiWip I�tp�efor for s�p�rah p�rs�ih for f6�n il�es. � - —'• AFP�,ICATION FOS BUii.Dll�� P$RMIT CITY �F FaID[.EY, MINP�SOZ'A � OWNSB'S NA� ' B�'ZI:DER � ' "t/ i ADDRRSS�C.U� 4M�ri : __ r DRESS _ _._� _ � LOCATION 0� bUiLDIATG . NO.�_�L:i i _._. STRBB? L� �(� BLOCK O� ADDITI�+T 0� SUBDI VIS Idii S COR�iEB LOT II3SIDE LOT��S:.'riBACR SIDE �_ _+ _ SEWER ELBVATION - TOP OF FOOTiNG Applicant attach to this form 1�io Certificates of Snrveq o.� Lot.aad proposed building location drawn o� these Certificates. - DBSC&IPTIObT � BDILDING . ' .:: �.� ., : �o Be Used �� . �Fr�t Dept ____._� Beight� Squsre feet Cubic Feet Pront Depth fleight Square feet Cubic Feet Type of Conetructioa Estimated Cost � J�� To Be Completed /�i�� The undersigned hereby makes application for a permit for the work hereia specified, agreeing to do all work ia strict accordance with the Citq of Fridley Ordiaances and ruliags of the Department of Buildings, and hereby � declares that all the facts and representatioas stated in this a plicatiaa are true and corr ct. /� �, / ��. /� DATE _ _ � � �_SIGRATtJBE _ _ , _ .+ _ _ (Schedule of Fee Coets can be found osi the Reverse Side). � JI � r O � 1 -.�� C� � � --' � - - � $t�i�c�ing Inspections 763-572-3604 763-502-4977 FAX DATE t� 2 Z� Z C� SITE ADDRESS f� G A r' THIS APPLICANT IS: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-09 YOUR v-- �c�w��_ F'i-� Cl O OWNER pJCONTRACTOR PROPERTY OWNER/ NAME: �1 � � TENANT ADDRESS: I �D PHONE: 7 J ? CONTRA,CTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: DESCRIBE WORK BEING SIZE OF IMPROVEMENT NAME: (9 �F l STATE LICENSE # ADDRESS � l� �a`'ti"° c9c l� �`�' � � �, v►�t n� S'S Y3Z � � ro �. tta �N�V✓ CITY �-f" � �y� � nl9CL.��=�. . �RA+�O��..-c PHQNE � S.Z ZZU S�'t S�� SINGLE FAMILY/NEW CONSTRUCTION S. ❑ TWO FAMILYMEW CONSTRUCTION S' ❑ ADDITION O GARAGE/SHED ❑ BASEMENT FINISH � ROOF ❑ DECK ❑ SIDING � SWIMMING POOL O NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR � j�REMODELING wi Permit No.: � V7-Ou' Received By: Date Rec'd: �-; —c9 r� oU ,. C�w`,-e STATE W�iJ ZIP� �v� (c�-�'S � �17G � EXP DA/TE' 3` 3�� y oo � CITY CT��-`� STATEM�IIIti'�LIP�s y�� FAX ZE 19ss'� rt./'L, 'ORI ES ❑ WINDOWS ❑ DRAIN T1LE �OTHER O � HEIGHT �� FT /(J7 � ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: I . Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor pian PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, D Vinyl QSoffit ADDITIONS & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1- Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes o LOCATION OF WINDOWS OR FOR NEW OPENINGS-DES E SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE iNSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 B FEE SCHEDULE) fOTAL JOB VALUATION $ �L ('� nF� :�►:� OCCUPANCY TYPE Permit Fee Plan Review Fire Surchazge Surchazge License Surcharge SAC Chazge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $� ;�5 See Back Page for Fee Schedule $ 3� 65% of Building Permit Fee $ O .001 times the total job valuation $ �,i .0005 x Permit Valuation Minimum �.50 $ �_�Y� $5.00 (State Licensed Residential Contractors) $ $2000 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$21 =$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ ►•'� �� Make checks payable to: Citv of Fridlev Attach THIS IS AN APPI,ICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and 1 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 Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of work which r uires rev' and approval of pl s. SIGNATURE OF APPLICANyG�f�'"7 v' ` i� �� PRINT NAME �/4f /' /y��Y� DATE l� �� • Z�� --F :� 11J • �` +'' � � � _..A w � � � T� :�� Yv `�_ - ' � �� 2 � `� z� �ry � ��"o � � � a� � � w � w � ---�'� �.S � � � � , :�, � - k � _ �. Y_ _ _; _ �I (c ��;.a 3..;=.��ft?i :..c:�l3_ � g0 � � �� x _ � � � � - �► �� ' � � � � � �� e� � �i � � �� $�� . � ��• 9� . � � � j �. �� . ��p �� . �� g � . �� .� � .�� A� �� .� $ ��,� �� 7 � � � � A r � � ° -- � . I� � g�39Sr 9� 5�3 =-- 6c?�?.�l��i I9 � � . .. . . . . . A .. . . . . �Rr` � : � . . � . . . . . . � \ � � _ t��n} 0��.2 �,�Z 1P � 0 � � � � r �� p a � � .S 1 � ��, � , �� 3 � 3 * z ' �''o � � � � � S �-��r ��"c `�"s � : .. �' ! 1 �"�,! � � � 5` � � ` _ :� �- � �" � � � .- w � Z -• - -• . � �4 3� 4'�' . il . ' ��•2e�� 's s � g- ' -�' o $ ' x 3 c`' �. J� �l � . �.,. � 3 � o �' � I � a �- � �� ;,�„ � ro.y _ _ � � � `° sz=+* o� - � �. s � � � 4�-w= $ £�' � � �" 1 �.±� ;....�`� � �� I -- _� � �.� , � .6- �._ ! � � 7 ' ' � � ; � ' -- i � � �, s � 3 � � '— �' � � z � �c ► � � � �� . � � * ��if s � �;= � � � � � � �, �- � � � f 0 r°- , ' ' '�� . . � � � � � Q r� �- � � � � � � _� � ' �-.. _ _. .--- --.. . . _ .... . . _; �0 3�'�•� 3"�:��f1H .�.dc13C LLZ9�9S=9_ 6�3:P,t 6�3��Z;��1i� �• �� z.,,; >?: S'_' ?5�5bEE_�i �rc, „l.: :',� -'.x �� .. . � r� . . . � . . . . .. . �: •�..+ � � � � . . BeemChek v200d Ncsnsed to: jIr Aon,� �aipn, LLC Rp / lOT7�J98s 8ennod�is BW�sJ Hsrold Resldanw � I�chan B�sms (max. load) D�te: tl21� � (2) 2n 10 DF-L w►1 l.0 � 0.0 Ft � NOS 2005 (kn BeaAng Area Rt= 1.1 irP R2� 1.1 M' (1.�) Dt DeA= 0.43 in Q� 8�am Span 11.5 A 8aoin Wt Oer R d.t4 ! Raa�tlon 1 TL 70i � RMCtio� 2?L 701 � 8m Wt k+dudsG 6e � Ms�dmum V 701 #� Wx MWneM 25�3 � I�lax V(R��osQ) T� Max DeA L/ 210 TL Rdt�al Dd L/ 106 � Soctia� i SAwr fn TL DeA � 4z�rs z�_�s o.� Crftlpd 27.74 5.22 0.73 91tlus OK OK OK Ratlo 659� t�x 59X _V�,� Ret�ence Vahies 1000 18� i.T Velues 1100 is0 1.7 � CF Size Fador 1.100 Cd Ouration 1.0� 1.00 Cr RspstMfve 1.00 Ch Shear Streas WA Cm Wst Use 1.00 1.00 1_00 Ct Sfab�lly 1.0p0p RD = 0.00 Le = 0.00 Ft L� R1 tlrr�orn+ tt: 90 = /1 LoaQ A R2 701 SPAN � 14.5 FT uniforn,.na portlN uNio�m bads.n bs p.. rn�l R. 8?5 ��+►� Cz.iC 1�-1- 5' �''c Ca- S,' k � J� ,�S = C � -z = -7o Co ,. ,, � �. � �� x 1� �� -'I� L�L � �� wl ��I �L� t 4 � � : , �r i:i � <2; _�0�9 ��9:5? ?E�56E�6i72 ' JEF?�' H�iFFI►-JE °F"'a� �a �, . ..._... .__._ _ - . ,� � BeamCAek v2008licenaed to� jA ho�ns deaign. LLC ReQ i� f077�9983 ° Bannochis Bidn./ Herotd Residence Kitchen 9eamS (max. load) Otts: ilZ11De � (Z)1�J�+�c T-4!s 2.OE l.P O�na-l.am lYL lu = 0.0 Fl �� S�^�,f� ' NQS 2005 Min Bearing Area R1= 0.9 i�' R2= 0.9 in' (t.S) DL Dett= � 85 k+ Q� 8eem Span 14.5 A 8eam VYt per ft 6.34 • Reactbn 1 TL 898 it Re�Ctbn 2 TL 6981� � Bm Wt Induded 92 At Msximum V 8981� � Max MomeM 2532 � M�c V(Reduoedi Tl Max Defl L/ 240 TL ACtuai D8A L/ 170 ; i �Qj� SeC1io� SA@Qf 77. �OA ht ' Aetual 30.66 25.38 0.65 Critical 9.74 3.31 a.73 Status OK OK OK Riltb 32Ye 13Yo 89'X j{�� Reieronce Val ustso v BL�i�ffit�.1� CF Size Fador Cd Duraffon Cr RepeGdve Ch Sheer Cm Wet Use ct s�aiay �t Fb Fv E si x mil ues 2950 290 2A - Alues 31Z0 290 2.0 1.058 1.00 t.aQ 1.00 . Strosa WA ' 1.00 1.00 1.00 1.0000 RD = 0_00 Le � 0.00 Ft Unifom� TL• 90 = A r� Ur�lfonn Losd A 0 .0 R1 � 898 � e ggg 8PAN = 14.3 FT Unifortn a�d partieU uniform b�ds are Ibs per Mneal R. �__ � �;�--�-�-f�"S '� i<<• �� 750 . � � �� ± �, i Building MECHANICAL ' Perrnit r�o.: �a 5 Inspections RESIDENTIAL APPLICATION Re�ei`'ed By � 763-572-3604 CITY OF FRIDLEY Dat¢��Ct� 763-SOZ-�9%% FAX EFFECTIVE 1-1-09 DATE 2-,3 "Q�I YOUR E-MAIL ADDRESS SITE ADDRESS (G c/ /�a��.cv� (��%c-/t THIS APPLICANT IS: O OWNER BtCONTRACTOR PROPERTY NAME: � OWNER/ ,�D� < 1a- /'�I. � 4 TENANT ' PHON CONTRACTOR COMPANYNAME: /% /�Ik.�•��`n o �,rA1�%'► � SUBMIT A COPY OF CONTACT PERSON: L''f ;/� .t •�w %., '.�.1 YOUR STATE STATE LICENSE # 43 -G/l�� 73&�'� 4 EXP DATE Q'— 2� � LICENSE WITH qDDRESS: //6Tb 2(,jt i�L�-e.c.L CITY S,� /"1. o�a.c � STATE�[P 5��. APPLICATION pHONE (7!.?, Y9�!- 26?% FAX(?G�� 4�97-�9`�b PERMIT TYPE 7��GLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK' � NEW ❑ REPLACEMENT �ALTERATION/REMODEL DETAILED DESCWPTION OF WORK f/-�•-� �;.-�g o.. L k�'�C L L-�-� (�Ood� /"ldt��l Gk ) ��%��-c •L� � /V.[ w �O C. e� 1�'e � B� S�OV-L PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of t6e total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $]0.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELO� Equipment Instaiied MFG: MODEL: SIZE/BTU MFG: MODEL: S[ZFJBTU MFG: MODEL: SIZEBTU _A/C 525.00 _FIREPLACE (GAS) SI5.00 �GAS RANGE/OVEN 510.00 _AIR TO AIR EXCHANGEER S15 _FIREPLACE (WOOD) S35.00 _NEW GAS GRILL 510.00 BOILER 535.00 _FURNACE S35.00 GAS UNIT HTR 510.00 CHIMNEY LINER 510.00 GAS DRYER 510.00 POOL HEATER 535.00 DUCT WORK 510.00 GAS PIPING 510.00 VENTILATOR SI5.00 Permit Fee � � . (� Number of fixtures @ $10.00 x $10.00 = $ Surchazge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $_�.� Number of fixtures @$25.00 x$25.00 =$ N�umber of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Total = $ THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL 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 City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit 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 pians. SIGNATURE OF APPLICANT �� Cc-.� PRINT NAME f i� c.v.c.a I�A �..�. `G�..!✓� DATE � D`t City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 City of Fridley Residential Mechanical Application Page 2 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC 0 NEW HOMES/ADDITIONS � EXISTING HOME ❑ MAKE-UP AIR REOUIRED FOR NEW/EXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. IMC Chapter 5 with MN Amendments 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a. Required on new construction IMC 1346.0312 5. Ventilation a. Per MN Energy Code 7670 or 7672 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for eombustion and make-up air calculations. Building PLUMBING Perrnit r1o.�a�012-to Inspections RESIDENTIAL APPLICATION Re�ei�ed By: MA� 763-s�2-3604 CITY OF FRIDLEY �� 6 Q� Q 763-502-4977 FAX EFFECT(VE 1-1-09 DATE �- 3' ��. YOUR E-MAIL ADDRESS SITE ADDRESS I L�T �A/�i+1lh C� %�-1 K THIS APPLICANT IS: � OWNER j�CONTRACTOR PROPERTY NAME: OWNER/ ,r�DRESS: CITY STATE ZIP TENANT PHONE: CONTRACTOR NAME: /`Za D � 1,,,•, �,',,., Q f�.<� ►_,'�� SUBMIT A COPY OF STATE LICENSE # Ov s'3 / 4 IdM EXP DATE / 2-.3/ — Q% YOUR STATE LICENSE, BOND AND STATE BOND # g3 07 9�q �� EXP DATE / 2- �/ - o�j CERTIFICATE OF ,e,Dpt�ss: f� bS° �G t Z 5��1L CtTV fl /`!, "�.l,.0 � STATE 1-� ZIP� INSURANCE pHONE L7GI i �%�'-17 �..2 D 3� FAX C% �� Y�I i—% 1�'� 0 PERMIT TYPE �CSMGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: � NEW �(REPLACEMENT DETAILED DESCWPTION OF WORK /�lal.�%�q �L'',' ��.�•� S'-+ �[ fo aiv,',r ��-c 1�t�.•l j PER MS 16B.665 the permit fee is a minimum of $15.00 or 5°/s of t6e total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost 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 $500, FEES ARE BASED ON 510.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOV�. MINIMUM FEE $15.50. BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPiNG (NEED CITY LIC) SWIMMING POOL WATER SOFTNER ($3�) CLOTHES WASHER � KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15) � DISHWASHER _ LAUNDRY TRAY WATER HEATER (S35) FOR IRRIGATION WATER METER OTHER Permit Fee $ �� ; .V� Number of fixtures @$10.00 x$10.00 = S Surchar e .50 Number of fixtures @$15.00 x$15.00 =$ TOTAL DUE $ _�(Z. � Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 MINIMUM $15.50) (MINIMUM $15.50 Total = $ THlS !S AN APPLICATION FOR A PERMIT-NOT VAL1D UNTIL PROCESSED I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance witti the ordinances and codes of the City of Fridley and with the Minnesota Conshvction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all work wbich requires review and approval of plans. SIGNATURE OF APPLICANT �lZ,,i,ILt�:� �AXi..:�a�+ PRINT NAME�;t�ha.c I�& I�-r,Dl•t.� DATE �-3-0� _� City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977