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P - 480061NML114025 �riS��Ctit}�!�' %�i�-3���-���� 7�3-50�-4977 FAX �" � . 1 � � . � • � 1 �A"F�' 11-23-11 Y(3E)R:E-i�iA1L ALI�FtE55 �y� qp���� 5685 JACKSON ST. FRIDLEY,MN,55432 T!!13 AFPLCCAN7' Is; i7 �WN�1t X CC3NTRAC"I"qCt C��'VNE�it �ENAI�T SUiiIvtlT A. �(3PY C?� YfltJ�i STAT� i.l�",�V�E, ROItIi� AND G�R'fIFICA'I'E C}F INSt.1RANCE i'ERM[T'�`YPE T'�`PE O� W�RIC:; t � / jl�cl�(r L�i:�L� �� . ,. � : M ��� ,r '� . � , "' j � �q�, DAVE SCHUSSMAN - ADBRE�S:5685 JACKSON ST. ��-y FRIDLEY S't'A'I'�.MN__ZIP 55432 ����+7�;, 612-432-1801 �p�Ey LINNSTAR TRANSFER STATE i:lCEIVSE tt 063901-PM EXi' i�r1'['� 5TA 1'E Af71V[J f#,� E?CF UA'f'E ADAliE�S< 9995 W 69TH STE 101 �r� EDEN PRAIRIE �.�.��.� MN �tP 55344 P�NE 800-856-6508 �AX X! SING�E FAM11:1' Cl N�SW CI TWt) FAMILY 01'(3WNEiflUSE X 12�F�LACEirrtET1T DE'�'ATL�D T3�SCRiPTt(}hI QF WpRi� REPLACED DISHWASER FEES AK� �A�SED UN $ip.fi0 PER FiXTUFIE, EXCk}'7` WfiERE NCITEi�. FTJiTURE3: (tTdDICA"i`E TflTAI. 2+1UMBER C}fi EACN ��tAW}. �,4tN11vTUtri F�E «'' $35.3t�, HATFT SiNKi1,A"V FF.t�7i2 t)ItAihIS _„ SbTCIV�R '1VA°CE� PtPING ��A7iiTU8 —' GAS PIPIi�€G (NE�p G1TY L1C} SWiA�tv1IN� E'C�OL � WATER Sf}FTN�R (S33) � CLC}iH�3 l�'�SH�R; �KI'i+�kTEN Sih�K '� WA'I'�R CI<C3SFT �'BA�iC�i.C3W PREV,(Si5) �� l�i�HlNeISII�it ,,m� LAUi+tpltY "Ii2AY �WATER R�ATER {S35) ��t7R tRRiCAT[i3Td ,,�, iA+A�Ft ME'iF,lt ,� 4TF#�Tt __.._ _ `I'XI[S TS AN A[�PI.i�;A,TI4N F�iR A P'&FttNIT-tdt7T �CALID Ui�filL PitCX:.�S�E[} i hereby apply Far a plumbin� permi� ar�d t acknrt,vrl�dge t�iat the infarmation above is ccrmpiete snd aecurate; ihat the work witi bc in confvrrn�nce with the ordinanc�s a�nd codes �itlte�Cily ofl�ridley and �v'rth the t4'Iinnesc�ta C�rz�sxructi�n Codes> Eh�i T understand ihis is not a p�rtn�t �ut anl� an app#icat�on fc�r a,perm�t arcd work is r�ot ta start with+�ut � pemi�t on site, that t�e wt�rk wi11''be in aaeorda��e with ihe approve�t plan in the case �f �11 work wk ` * .e apProaal of nla�s. �I��������'��'�'��� .. AWt� CHARLES GABRELCIK nA•rr_ 11-24-11 , / Ci� of �ridl�y Buiiding Tnspect�+�ns llep�rt�e�t �43 � Ur�iv�rs�ty A;venu� NE, �ridle�, h!TT�1 SS�32 763-572���U4 E`�l\'. l�J���L�T/� PLEASE SEND PERMIT TO HOME OWNER!! �1 L3 l � • � r. v�