P - 36940From: +763 428 6779 Page: 1!1 Date: 4114/2011 9:58:17 AM
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Building LG11��.]�! Y,YMIT Permit�o.4�a�(-OU �
Inspections MODIFICAT�:�N APPLYC.�TION I�eceived By:
763-572-36�4 C�TY i.D]E� FRYI�LEY ��'��°�R
763-502-4977 iax cr.crr�•rnrc i, �a
APPLICATTON Dr�TE: � � I� � t� ,_ YOUR E-MAIL ADDEtESS: L�C���I Ci.� � VG. �� V
THIS APPLICANT IS: �HAULER ❑ PR4FERTY O�PJ��IER
PROPERTYOWNER: �,_�v�.+O� C–��', �+�'`� �
JOB ADDRE^�S:
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MATERIAL TO BE HAUL�D:
MATERIAL BEIN .f'r HAULED BY: � j��. �r �,�1 �'�(J C7� G.�.k. �
DAT�S TO $E HAULED (UP TQ 3 DRYS): ��VI ���—
THIS PfiRMTT IS (�SUED TQ ALLOW AN INC�EASE O� AXLE WEICHT FRQM FOUR (4) TONS PER
AXEL TC} F1'VE (5) TONS PER AXEL OVER Tl-lE F4iLOWING DES�GNA7'ED ROUT'E:
N�TIC�: 7'his permit is valid only for vehicles enroute ta construction addres� during the hours af $:00 am to
5:00 pm. See Resolution #O1-2d0� and State Statute Section 169.87
PE�tMIT MUST BE IN'V�HICLE �1,�I.ILE X�AULING ON ESTABLISAED ROUT�.
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TfIiS 1S AN APPL1CA710N F�R:�. PERMTT-Nd'f VALED LTNTIL PRQCE:iSFD
PERMI'Y' FEE: 9i25.00
I hareby apply for a load limit modific�ion permit and I a�kr�owledgc that the information above is compl�t� and accurate; that the
work wili be in canformance with che ordinances and cades of the City of Fridlcy. I under.;tand this is not a permit but only sn
applis�tion for a permit and hauling on rtsuicted roads is nat t�_� seart without a permit.
SlGNATT.lRE OF
A�'PROVED BY
COPt�S GNEN
Ciiy ��f �`ridley
Building Ynspr.ctions D�partment
643] University Ar�enue NE, firidley, MN SS432
7�53 •572-3604 �
FA3f: 763-502-�4977
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