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AF - 47413• � U C� City of Fridley, Minn. BUILDING PERMIT nate: ___. aune 2s , 1965 �� N� 8051 � �onstr. C pa,�.: M8X J. MOlus Builder _. .. �•..-..- Addresa _..�816 SCOtt AveIIUe Ido. ..� Address —..$t>tt'l',e 5�rlok�t�_M3.n11eao't.s � LOCATION OF BUILDING No. b�___. st�eet Jackson �treet N. $. ._.._..__.._.._..__.._ Part of Lot Lot �......�_..�._� Block I _.�._.....__. Additimi or Sub-Division .� .�_.�.� ��tOAe TeTT8t3e Corner Lot ._ ._..__ Inside Lot _._.?�..._..._._..�... Setback __._..____.._._.._.._ Sideyard ___ Sewer IIe�vatioa Foundation IIevation DESCRIPTION OF BUILDING To be vsea as: �.1FTe11iT1�K dc Front _._..____.�. Depth Height .._._....._..., Sq. F't. .� Cu. Ft Gar_. a�e ____._ Front _...._.. nepth __ xeight _.._�..�._ sq. Ft. _ cu. F't. Type of Construction _ F...T.�,�.._.._.___._.� Es� C�t ��.s-� !� .__....... To be Completed ...._.. ...:_ New Dwe31iz3g� Gara.ge In conaideration o! the issuance to me of a permit to construct the building described above, I agree to do th� proposed work in accordance with the description above set forth and in liance with all pro�visians of a�dinancea o! the dty of Frfdley. � 0�1� l . In caa�siderattaa o! fhe payment of a fee of �--��-QQ .., permit is herebY 8ran'ted to Doaald Bastrcm, D3V3.3 GOAS'�. �O. to c:onstr�uct the building or addition as descxibed above. This permit is gi�anted upon the express conditiott that the person to whom it is granted and his agents, employees and workmea, in all work done in, around and upo� safd building, or any part thereof, shall conform in all respects to the ordinanoes o� Fridley, Minnesota regardinB location, cwnstruction, alteration, maintenauce, repair anti mo�vin8 of builc]ings within the dty limits and this permit may be revoked a t ar�y time upo� violation of any of the provisiana of said ordi�►anc�. Allea Jensen B�� NOT{CE: ihk p�emit dae Rot em►K tlw eeealloeHan, hnhll.�ta� ter wieL�. v�w w� �•�a. +�+' or wata. s. aw� to sN 1h� duildloY �o�p�els� for aW►+1'� pMnih for fha� h«ns. .x ` ` ./ r. . ' APPLICATI�N.FOR BtTILDiNG PERMIT •. . CITY OF FRIDLEY, MINNBSOTA / / a / � �. . �' �/ a � / �� I�.� � � i, � ' / a�1 / � � 1 1 ' II � ��' � . 1i� �� - / - f 1 ' �� L� . �i LOCATION 0 DING � . � � � , ., No._ � � � Street - f�ot s .�_ LOT � BLOCK ADDZTION � SUSDI.YISIO , ��e�-� a, . D��s. Corner �ot�_Inside;LOT�Setback �� 5ide-Yard `�� f ' � ,,�� $EWER ELSVATION FOUNAATI0�1 ELBVATION . � Applicant attach to this form Two Certificates of Survey of Lot aud propqesd building location drawn on these Certifica�es. � -- DESCRIPTIO�TT OF BUILDING . To_be used.�s: . . , �. � �G�1L_ Front L} ,3 Depth � . 8 - 6 . Seight,�l , _ . Sq. Ft . �Gi �. �a . Cd: Ft . ��1� �"-� Frant�_Deptli o2 -- H+aight . . ! � -, . _ Sq. Ft._ .So� g Cu. FC: ��,�� . � � Type of �ouetruction �v'�v� Estimated Cost ��D � � To be completed �,.P�� 6 S The undersigned hereby makes application for a permit for the work herein apecified, agreeiag.to do all work in strict accordance with the City of Fridley Ordinances aad rulings of'the Depaxtment:of Buildings, and he�eby declares that,�11 the iacta and repre8entations stated in this'applica�ion.are true and�corxect. ' / Q �� .� (� �� 1D 5 S?[:NATfiRF ,�7/9�.�ewh�l vs w t� (3chedule of Fee Coats can be found on the Beverse Side). � . • � �� tJ ij, SUBJECT PE . City of Fridley 19058 AT THE TOP OF TFiE TWINS g U I L D I N G P E R M I T r ' ' RE � � • � ; y � COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. �-S3O Z l� t , -__• A ��'�� ,j CITY HALL FRIDLE�' 55432 NUMBER REV. bATE �PAGE OF APPROVED BY i �� 612-571-3450 910-F15 7/9/87 / / JOB ADDRESS 6456 Jackson Street N, E. 1 IEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 Ortenstone Terrace SHEET 2 PROPEfiTY OWNER MAIL ADDRESS 21P PHONE Nrax Molus 6456 J'ackson Stxeet N. E. 571-1538 3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO. Top Notch Constx�uctian 1218 - 153rd Lane N. E. , Ham Lake 55304 434-5986 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL AODRESS ZIP PHONE LICENSE NO. 6 USE OF BUIIDING Residential 7 CLASS OF WORK O NEW � ADDITION ❑ ALTERATION ❑ REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Construct a 12' x 10.75� Entxy and a 12' x 22' Deck 9 CHANGE QF USE fROM TO STIPULATIONS See notations on plan WARNING Before digging cati laca! utilities SEp�1�R�1� �� R�j�� T�LEPHONE - ELECTRIC - GAS Ets, Vt�1��, ��A��, ��.t�� 4�uD S��N�. IREQUIRED BY tAW SEPARATE PERMITS ARE REOUIRED FOR ELECTR�CAL, PIUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONWG. 7HIS PEAMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONIIJG SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OFi IF CONSTRUCTION OR WORK IS SUSPENDED Ofi ABANDONED FOR A PEfiIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTqEET PARKING I HEREBY CERTIFY THAT I HAVE REAO AND EXAMINED THIS APPLtCA710N 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLtED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S$ �OOO $i. OO DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERF ANCE OF CONSTRUCTION. S6S. SO PLAN CHECKFEE TOTA�FEE $17.13 $89.63 SIGNATUREOFCONTRACTORORAUTHORIZEDAGENT DA7 � , � WHEN PFOPERLY LIDATED THIS IS YOUR PERMIT r SiGNATUAEOFOWNERIIFOWNEABUILDERI IDATEI �BLOG INSP TE NEW L � City of Fridley Effective 4/1/8 6 ADDN. [ ] �R-1 AND R-2 AI,TER. � 3 Building Permit Application Construction Address: �-�� -� � � �S' v� �� — Legal Description: �,�� Owner Name & Address : ��i� X- a � L � � � '�� SC � Tel. � �L�`3� r, j � 1- � ,n � �-�-L ��,• / D � /v07Z�H � �tJSr�2c�u7a�✓ Tel . � �� 8�' Contractor • ,, � �� _�� Address: - ,� , ' Oc 4'YI ��'� � 6" �, l 1-i h J�_i .3 G' � Attaeh to this application, a Certificate of Survey of the lot, with the proposed construetion drawn on it to scale. ��;�r �A: GARAGE AREA: DECR AREA: OTHER: �� a5 x �a� Corner Lot [ ] DESCRIPTION OF IMPROYEMENT � Length �_ Width �Q,� Height S9• Ft• t2�'�� Length ,�� Width _ Height Sq. Ft. Length �2 Width 2�� Hgt/Ground Sq. Ft. � . , ., _ : �,a79 ,�i 2. �r Inside Lot �,j Cac 4 x�,�c� = ��a9, � S ��°`�.a `� F t. Y d. Setback __ Side Yard Setback c� Type of Construction: ,_ � r� +°►� '�-- Approx. Completion Date: ttC, /.�, �9�� Estimated Cost: $ '�� $.Oo-v Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: see Back Page for Explanation �/� ��I�— Ga DATE: �� APPL ICANT : N�-�l �� f �-�%�-'LG�� Tel . #� 3 �- �[ (1 Permit Fee Plan Check State Sureharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS�� CITY IISE ONLY $ e'� . So $ � � �O $ � � ^ $ � � 3�. t,� t� [�1�,Co3 � Fee Schedule on Reverse Side 25� of Building Permit Fee $.50t$1,000 Valuation � 525 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] 0 �60� - � a oa� - 3a ,S� ��G 36.Do G S �sti City of Fridley AT THE TOP OF TME 7WINS � � � � � � ; v ___._ COMMUNITV OEVEIOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. 1 . � � _ �"'1 � CITY MALI FRIDLEV 55132 �""�� '' 612-571-3450 10B ADDRESS 6456 Jackson Street NE SUB�ECT BU ILDING PERMIT NUMBER RBV OATE PAGE OF 910-F15 5/7/99 / / t LEGAL �OT N0. BLOCK TRACT OR AOOITION OESCR. 3 1 Ortenstone Terrace 2 PfiOPERTY OWNER MAIL AODRESS 21P PMONE Max Molus 6456 Jackson Street NE 3 CONTHACTOR MAIL ADORESS IIP PHONE Northern Sun Builders 772 Mississippi St NE, Fridley, MN 55432 1 ARCMITECT OF DESIGNER MAIL AODRESS ZIP PMONE 5 ENGINEER Residential 7 CIASS Of WORK O NEW MAII ADDRESS O ADDITION � ALTERATION 8 DESCRIBE WORK Reroof House & Garage (28 Sq) Tear-off 9 CHANGE OF USE FROM STIPULATIONS TO PHONE 391 �5�6 APYROVED B1I SEE ATTACNEO S►1EET LICENSE NO 502-9474 LICENSE NO. 6562 IICENSE NO � REPAIR O MOVE O REMOVE Underlayment must comply with the State Building Code. CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to 9:00 pm on Saturday; No work on Sunday. SEPARATE PERMITS ARE REOUIRED FOR ELECTiiICAL, PLUMBING. HEATING. ''r� v v�..�. VENTI�ATING OF AIR CONDITIONING. TMIS PEfiM1T BECOMES NULL AND VOIO IF WORK OR CONS7RUCTION ZONING AUTHORI2ED IS NOT COMMENCED WITMIN 60 DAYS. Oii If CONSTRUCTION OR WORK IS SUSPENOED OR ABANDONEO FOR A PER100 OF 120 OAYS AT ANV TIME AfTER WORK IS COMMENCED. NO DWLG. UNITS I MEREBV CERTIFV THAT I HAVE REAO ANO EXAMINED THIS APPLICATION 1 ANO KNOW THE SAME TO BE TRUE AND COpRECT. ALL PROVISIONS Of �AWS VA�UATION AND ORDINANCES GOVEpNING TMIS TVPE OF WORK WI�L BE COMPLIED W1TH WMETHER SPECIFIEO MEREIN OR NOT. THE GRANTING OF A PERMIT �2,399 DOES NOT PRESUME TO GIVE AU7MOR17V TO VIOIATE OR CANCEI TME pERMtT FEE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON• STqUCTION OA THE PERfOpMANCE Of CONSTRUCTION �]�F.7S PLAN CMECK FEE l' � .5=�-GG Licen � S�GN�iUpEOaCON.1'tr�(�papa��THOQi2E0��GENT iD�TE� ucu i STA�LS $5. Ncv �oAo OFfSTREET PARKING IGnRAGES SURTAX �1.20 SAC CNARGE Fire SC $2.40 TOiA� E ,�83.35 �/'!�/�� —� ` � iD�rE� a.�e �tito pGlF NEW ADDN ALTER [) [l � ConstructionAddress: _ Legal Description: Owner Name & Address: Contractor: Address: �/__� LIVING AREA: GARAGE AREA: DECK AREA: OTHER: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AN� R-2 BUILDING PERMIT APPLICATION c.J C�' ��Gc C' GCcJ C�^� � 0 � /��r/'li'r'ri � Effective 1 / 1/99 r � �. � f ��\ �� a Tel. # .�MN LICENSE # ��Z.-- � Tel. # �/� ��S`a �- �¢7� 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 Length _ Width Height Length , Width HgdGround � � Sq. Ft. Sq. Ft. Sq. Ft. - � ,�� Fstimated Cost: $ a -- �� `� 9 Co11StruCtioII Type: � G- r - .. (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ Tel. � � 5 ��--r� DATE: ....5 = AP'PLICANT: ��- Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ ��?.��` $�� 7 U $ / �O $ $ �vv $ $ $ $ � ��•�� CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.50/$1,000 Valuation $1050 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary ( ] Not Necessary [ ) .. . . r sue�ec* PER . c�ty of Fridley 32475 AT THE TOP OF THE TWINS g � I L D I N G P E R M I T r � � � • COMMUNITY DEVEL4PMENT pIV. O j � � � PROTECTIVE INSPECTION SEC. /� 7,� � � `.--- w;��;'� CITY MALL FRIOIE� SS132 NUMBEP REV O�TE PAGE Oi APiROVEO 9Y L �� 612-571-3450 9t0-P�S 3/25/02 / � JOB ADDRESS 6456 Jackson Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO OESCR. 3 1 Ortenstone Terrace SNEET 2 PiiOPERTY OWNER MAIL AOOR�S$ 21P PMONE Max & Irene Molus 6456 Jackson Street NE 763-571-1538 3 CONTqACTOR MAIL ADORESS Z�P PMONE UCENSE NO Mon-Ray Ir.c 801 Boone Ave N, Golden Valley, MN 55427 546-8625 0005111 � AfiCHITECT OR DESIGNEfi MAIL AOORESS ZIP PMONE LICENSE NO. 5 ENGINEER MAII ADDRESS 1�F PMONE UCENSE NO 6 USE OF BUILDING Residential 7 CIASS Of WORK O NEW O ADDITiON O ALTERATION � REPAIR ❑ MOVE O REMOVE 9 DESCRIBE WORK Re lace 8 window sashes 9 CHANGE OP USE FROM TO STIPULATIONS Provide smoke detector� in all sleeping rooms azd on aIl levels o� the dwelling per Section 310.9.1.2 of the 1997`Uniform Building Code. �'ermit �nspec�ron wt�� e� M �'ar�� r0 �omeown a11ed er To po�� SEPARATE PERMITS ARE REOUIRED fOR ELECTqICAI, PLUMBING, MEATING, TVP OF CONST. OCCUPANCV GAOUP OCCUPANCV �OAO VENTII.ATING OR AIR CONDITIONING THIS PERMIT BECOMES NULI ANO VOID If WOfiK OR CONSTRUCTION 2ONING SO. fT CU FT. AUTHORIZED IS NOT COMMENCEO WITMIN 60 DA`1S, OR IF CONSTpUCTION { OA WORK IS SUSPENDED OR ABANQONED POR A PER100 OF 120 OAVS AT ANV TIME AfTER WORK IS COMMENCED. ` NO DWLG. UNITS OfFSTREET PARKING I HEfiEBV CERTIFY THAT 1 NAYE REAO ANO EXAMIN�D TMIS APP�ICA710N 1 S7ALl5 GARAGES AND KNOW TME SAME Tp BE 7RUE AND CORRECT. ALL PROVISIONS Of LAWS VALUATION SURTAX ANO ORDINANCES GOVERNING TMIS TVPE OF WOFK WILI 8E CpMPlIEO �]�OOO � �3.SO WItM WHETMER SPECIFIEO MEREIN Ofi NOT. 7ME GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTMOR�TY TO VIOLATE OR CANCEL THE pEqMIT fEE SAC CMARGE PROVISIONS OF ANY OTMEFi STATE OR LOCAL LAW REGULATING coN• �139.25 Fire SC �%.00 STRUCTION OR THE PERFORMANCE Of CONSTRUCTION P�AN CNECK FEE TOTA� FEE License SC $5.00 $154.75 S�GNITUQE O� CON'RACTQii Op �UTNOp�2ED �GENT iO�rE� NEN PROPERLY VALIpATED THIS IS YOUR PERMI 3 � � �1 S�GN4TUQE O� OWNEQ�� OwNEaBwIOEfi� �OATE� � ' � BlO �h �' � O�rE rrEw [ ] A�DDN ALTER Effecti�ve 5110/99 [ l CiTY OF FRyI1LEY � [ l SINGLE FANIILY AND DiJP'L �+�t-1 AND R-2 �UILDING PERMIT APpT ICATIOIV Constxuction Actdress: 6456 Jackson Street NE Legal Description: Oovner Naxne & Address: Max & Irene Mol us 6456 Jackson St NE Tel. # 763-571-1538 Contractar: MON-RAY, INC 801 Boone Ave. No. ��C�SE # 0005111 ��: -Golden Valley, MN 55427 �e� � 546-8625 Y.Y'V'IlV'C AREA: GARAGE Al2EA: Y3ECK AREA: 01'�R: Attach co �s application, a Certificate of Sunrey of the lot, with the proposed constru,ction drawn on it to scale. � D�SCRIP'1`ION OF Il4D.'RO�i'EM�NT Length widtb. Hei�ghc I-e�n�th Width �%ight Sq. F�t. Sq. Ft. Length Witdth HgtlCnound Sq. Ft. Replace (8) Window Sash Consfruct�on Type: Res i dent i a 1 Fswnated Cost: $ 7, 000 . 00 Drive�ray G'�rb Cut'Width Needed: Ft. + 6 Ft - Ft x$ _$ � DA1'E: A��,ICANT: Te1. # 546-8625 Permit Fee Fire Surcna�rge Statc Surcharge SAC Chazge Y.icense Swtr,�arge Driveway Escraw Erosion Cornrol Park Fee . Sew�r Main� CY�uge TO'T.A,L crr� usr o�.Y $ 139 . 25 �� on Reverse Side $ 7 . 00 .0010� Permit Valuation (1110th�} $ 3.50 � $ 5.00 $ $ $ $ $ 154.75 $.SO/$1,000 Valuation $1050 per SAC U'nit $5.00 (State Litcez�sed Residencial Contractors) A1t. "A" or A1t. °B" Above $450.00 Conservation P1an Revi,ew Fee Determined by Engineering Agre�ment Necessary [ J Not Necessary [) ST.�ULATIONS. � .2s` o z �9iZ0' d L1.689bS Ol Y J;3�Q I21.� �0 Al I� W021� 6£ :60 666Z-LT-�Il ADDRESS . PIN . LEGAL DESC . PERMIT TYPE . PROPERTY TYPE . CONSTRUCTION TYPE . CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 �63) 572-3604 FAX: (763) 571-1287 6456 JACKSON ST NE 143024410114 ORTENSTONE TERRACE LOT 3 BLOCK 1 PLUMBING RESIDENTIAL ADDITION/ALTERATION ,� --. ,.. `^� PERM NO.: 2004-01284 _ __ , DATE ISSUEDc 0$C69/2004 VALUATION : $ 400.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A GAS WATER HEATER. # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0 # NEW FIXTURES (EXIST OPENINGS) # GAS DRYERS VALUE (FOR MINIMUM CALC) APPLICANT NORBLOM PLUMBING CO 2905 GARFIELD AVE S MINNEAPOLIS, MN 55408-21�3 (612)827-4033 OWNER MOLUS MAX J& IRENE R 6456 JACKSON ST NE FRIDLEY, MN 55432 0 # GAS WATER HEATERS 0 # OF NEW FIXTURES 400 # WATER TRMT APPLIANCES PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) PLBG FIXTURES (EXIST OPENINGS) WATER TREATMENT APPLIANCE WATER HEATER - ELEC GAS DRYER FEE PLBG REPAIR/ALTERATIONS STATE SURCHARGE, PLBG FLAT WATER HEATER - GAS TOTAL PAID WITH CHECK # 28814 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wor� will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regG� cor�struction or the performance of const,�uction. 1 Bldg Ins� � SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 1 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.50 35.00 35.50 . ;ITY OF FRIDLEY INSPECTION DIV. �431 University Ave NE =ridley, MN 55432 763) 572-3604, FAX (763) 571-1287 Effective Aprif 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT �� MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR 'LUMBING FfXTURE RATES: NO. RATE TOTAL Jew Fixtures �Id Opening, New Fixture 3eer Dispenser 31ow Off Basin ',atch Basin 2ain Water Leader 3ump/Receiving Tank Nater Treating Appliance Nater Heater -Electric Nater Heater - Gas" 3as Range*; 3as Drye�=' 3ack Flow Preventer Required OYes O No Type $10.00 �10.00 $10.00 $10.00 $10.00 $�o.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.Q0 $15.00 2einspection Fee $50.00/Hr 4LL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25�0 of Value of Fixture or Appliance State Surcharge TOTAL �EE JOB ADDRESS_ �' ;Q � aS n'W Vl�tni The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work i� strict accordance with the city codes and rulings of the Buiiding Division, and hereby declares that all the facts and representations stated in this aoolication are true and correct. MOLUS, MAX 6456 JACKSON STREET NORTHEAST FRIDLEY, MN 55432 OWNER �763) 571-1538 BUILDING USED AS �51 �e�1G� N �-J -7/31 , Zo b�— ESTIMATED COST �� O� PERMIT NO. �D� CI " �-=1 �L 1�� PLUMBING COMPANY O�� 'Wt t SIGNED B TEL NO.i��o�Z� gZ%—�033 •� Approved By Rough-In Date Final Date $ MINIMUM FEE FOR ANY PLUMBING/GAS PERMff IS S15.00 or 5°� OF COST $�S• � OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. COMBUSTION AIR SHALL BE PROVtDED PER UMC SECTION 504(A) AND TABLE 6-A. '*PROVIDE COAAMON VENT INFO ON BACK SiDE