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P - 48539i � I I � �� From: 612 822 5408 �� Page: 213 Date: 3/8/2012 4:21:10 PM ��r�� Building PLUMBII�G . __ Inspections ��IDENTIAL ,�.��''X,XC,A,�'XQN' 763-572-3604 �YTY �F FRIDLEY 763-502-4977 FAX r.r•r•EC�v� �-i-zotz DATL• �Iy�ZC(� J � SITEADI]hES; %�j i �� K��/i TTiISAPPLICAIQTIS: ❑OWNER t��o��;x•rY Y'OUR E-i�fAIL ADDRfi55 � ONTRACTOR Permit No.: � �'�%-(�� R�ceived By:,� �( !"`gf k j, �.�, ' r �� t� � !�� -P ,�e� cl: NAMR: Lt�IL c 1 � QWNER/ Annr�►?ss.�5 13 �,..��"%ip�.� ��t7 c1'r� T-� �+��'� ST�TGiP rn�7�l�i�'Z. TENANT — PIIONH� ^� � � � 0 �LiG�� CONTRACTOR NnME: �" u�'J_�p,�r�„f � G �v,,�{�/r/� SUBMTI n Cal'Y OF c� - Y0'UR STA'1`E STATF I.IGEI`15E �l [ � �� % � � �}(p D��'I'C T.IC:ENSE, $OND A�II� STATT DOND u FxP llA'I'� CEFTIFICATE OF p�DR��; 1�'�7 L� �j �� ,/ CITY /N�sle�f$d'Lff STATE�ZIP�'� I INSURANCE PIIONC �i�/2. 6 p�� 1'�� g� �"^ FAX PEAMiT TYPE TYPE OF WQRK: �1N(}I,F.. FAMf 1,Y ❑ NCW CI TWO FAMILY ❑ TOWNI�IOUS� �i�YLACEMENT DL'1'AIl,�D 17LSCI71NTtON OF WORi4 '�C'� !_'C t�,9 i� --J7�=�' %�- � FE�'S ARF. BASF,I� �N �10,00 PER FIX'TURE, EXCEPT WIIGI2E NOTCb. �IX1t1RES: (1TIb1CA�f�'f01�AL NUM�3ER OP �ACI�i II�LOW). MINIMUM FEfi 535.50. . DATI�ISINK/I,AV FLQOlt I)RAIN� SHOWEIC WA'I'�R PtP1NG � BATHTIfH GAS FIPING (N�CD CIT'Y LIC) , S W tMMiNG YOOL WATL•R SOF'INER ($35) _ GLOTf-�S WASHEI� KITCIIGN SINK � WA'fFR CLUSE"I� BACKFLOW PIi�V. ($ IS) _ D]SIIWASIICIL � I.AUNllRY TAAY =WA'�'E�i HFn7�'�{ ($;�5) FUR Lli.ftl(iATCON _ WAT'BR METER _ DTHP, R TI-II3 IS AN AFFLICATION PQR A��CtM1T-N07' VALID UNTIL P1LdCGSSGD T hereby apply for a plumbing permit flnd T Acknowleclge thfit tt►� inforn�ation above is oomplete �tnd accurAte; that the work will Ue in conformnuce with the ordinflnces And cudes thc C'ty ot Fridlcy and witii tlic Minncsola Construclion Codes; that X undeA•stand this is not a peattiC bul �n1y �n applioatSon f`or a,crni work is npt to 5tart without a�em�it on sitc; thxt thc work will be in Accordance with thc approved pIan in_th��e o all tiv k 1i re uu•es raview and app�x�1l of plans_ ,.� SlGNA1'URC OP APPLICr�NT • PRINT i+lAMF. '�Vl:'e LL�,i�D��f�� DAT� t`�-r�i �� APPE20'V�L D�iSP�C"tOT2S S1L'NA'l UkL� , j ------ va77:�-,� U C�ty o� k',rxd�ey I3uilding Z�spec#xon�s �epartment 643 i llniversity Avenue NE, Fridley, MN 55432 7G3,572-3604 FAX: 7b3-SQ2-4977