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P - 37114Bui.�d�.�g Ynspectxo�s 763-572-3604 7�3�-502,4977 �',A� From: unknown Page: 1/2 Date: 4/25l2011 3:4420 PM fr�G f�.� � c�(�-�-'�G-C� pLiJM�ING RES�DE�TIAL A�'PLI��iT�UN CITY tJk' FR�ULEX �r� � -�-! -- � ���� e / Permit �To Received By;Jvl D��'e'�e�ci: '� � DATE_ f �L }� � � � XOU� �-MAIL ADD�ESS - � SI'#'B �A,bDRES5 � �T `L� - - lTt�.�G'Y'" S a....�- 1� ' S/••~f � G� �/`� 'x'L�IS APPLICA1vT I5: Q OWNB�i �ONTRAC�'Q� owlvE�t/ �ra��ss; ¢ 7 �-� �fi�'�s�,.� .S , ,Tx r�, I sr�.T�hz��e �,�"�J Z, ��vA1VT �xorrE� � �2-���f -2..2.�r�.. �o���� NAME: ��7'T.'-� �,� r���,�. � SU�M�' A COFY OF sTAT'a I,JCfiNSIE � a. �-? YOUR STATE f�� S_ S /� �xF DATE f 2-'.� !�/'L LIC��`1S$, �OZ`1D AND STATE HONDlf C5 �,/ g3�} �_ E?CP DATF 1'L �P!- !! C��'�'�FICATE OF ADDRESS: YU 6.� �'° S'�he�dj- S'pT.TN CITY dN7x.4� �r"t� _STA'�&N►� ZtP J�i� I1VSU�A,IYC� PHONE �Z.F/^L.S f ^� �0�-�. ''��� � , FAX � �! " ��f � P�RMTT 7'�1'�� T°YPE UF WO�: �SI�iG�.� FAMILY 0 tVEW C1 TWO FAMfLX ❑ TOWNkiOUSE �REPLACEMbNT DE'Z'A,U.��.7 DESCRIP'TIO�T QF WORK t��l�e�. �c f�i e.�at � ��S ARE BASED 0[� $XQ.00 PER F[XTU�t�, F_,fCC�FT WHE�$,NOTBp, FIXTtJAEg: {JNI7iG1TE'�OTA�, NUMSEK O�' �,AC�t BELOW). M(NI[�UM FEE $35-SQ- � BA'�'k� S�Ni�/L..AY FLOOR Z1�H,�NS SHOWF�i ,,, WA"� piPING � HA,'�'Z'I7� _ GA5 P1PlIVG {NEED CITY 1�IC) _ SW1N�Mf�I.Cs FOOL WA�� S��iA)ER ($35) CLp'fH.ES WASH�R _ i{ITCHE�i SI� WATE�t CI.OSET _ SAG�.OW PREV. ($,t5) � �IStzWAS�ER _ i.AUNDRX'�AY _WAT��t �BATER ($35) Fo�t I�i�tiGAT10N ,_„ w,AT�12 METER _ U'�'klER TI�JS �5 A,N FIPFLICqT[QN FOR A PEKNxI'�-(YpT VALID Cl�'I'��. PfiO�ESSEA7 I hereby app�y �o� a plumbing per�it and i acZc,uowied,,� that t�e xnfarmatip� above is co�g�ete and accucate; t�aat the woz� will be in� conforman�ce w�t� the ordir�ances and odes t�e Cit� bf k'nid�ey and with k�e �innesota �o�structian Code�; ��at I unde�stand this is ilOt 8 p�m3tt �7u� t}p�y g� appjjC�XiO� �01' 8 Pe ' a�d�ork is �ot to statt wit;��ut a�ermit Q� site; ChBt tha wpf� W��l be in acG4Xd$nce with the approved Qia� in the c e a�' at� work h uires review and approvai o� plans. 57GIVATU�t� Ok' FIPPLIGANT '� � NT NAM� ��1+� '� I%�..- J�A� �'{" z'�Y �I AFFROVAL INS�'�G'x'ORS SIGNATURE _ y - � `�— - City Of �'�i�1ey Bui�dx�g Inspect�c�ns Depaartment 6�t3� U�iversity Av��ue NE, �r�d�ey, MN 5�432 763-572-3604 �.A,�: 763-502-4977