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P - 41768From: unknown Page: 2/2 Date: 9/30/2011 9:42:53 AM �uilding PLUlVI�ING Inspec�ioz�s 1�SII�E�7'YA�., APPL��ATIU�1' 7��-572-364� CI'�'�Y O�+ �'RID��Y 7b3-S02-4977 FA� E�FEC7tVE 1-1�ZO1� SITE AD1�RE5S _ THiS APFLICANT 1S; PRO�ERTY a�+�r��r TENAI�'i SU�M1T A �OPY'OF vou� sT�r� L.tCENSE. Bt�Np ,,4,�fD cE�rY�tCa� a� INSURAIVGE ���[tr �rv�� TYPE O� WQRK: u YOUR E.MAIL ADDIt�SS k W V IJ.�. C# (1WNER i�CONTRACTOR YHUNE:�1�` 5 � N,AME:�� f!►.1v�..� S , sra'� �,tcE�a� # � STATE 80Np # ,� ADbt�ESS: � � � � � Pt�or►� �: �„QS'- 4 �'� 'i�$1AIGLE F,0.MILY o r�� lyE1'AIL�A D���IPTt�N +pF' i, S U— F,7..i-F-4 O �_ .- `t"i r�.. P t.� r« � (E &'! is�— P hri �,os�rQ�r� �i�.�.ui � �1� 1�►� d isx;� p( t3 ati.{a-t:Y' --�-� e, -,.�� ❑'Pw� FAMIL'Y ,��s��,,�c$n�t�nrr P�rrr�iit Received B�y: �����.e� � � crr�r � �' � �� 7 sTa��z�� SS# � FAX ❑ -�ov++�r�ous� �x� on� t �- f a �� �,� i' �- � .'7 -� csv FEES ARE BASElJON SIO.Qtf t'LR FiXTURE, ESSCEPT WHERE NOTED. FIXTURES: (Lt+fQICATE `COTAL I+fUM��R OF EAGH BBbEiW?. MINItNE1M FEE 535.38. _ BA�TFi S1NKlL.AV _FLOOR Diit�INS � 5�t0'WER W,AT�R #'fPM� _„ BATHTU$ ,_, C�AS PIPMG iNEED CITY L[C) SWiivlM�NG P(i�L ` WATER SCI�'�'NER (S3Sj _,.,CLt?Tt1E5 WAS}�t�R T KI�'CktEN StNx wATER CLpS�"i' _, BE►CK�LOw P1t�V. �SlS� _ 17iSFCWASHER , LA13t+Ib�Y TitAY �WATER HEATER (�35) FL)R [ttlLlGATt01�t ,. _ WA7'�R MET�ft _ ti�`t3�!'t . . . , . .t.: . , . • :, . •,.. � . N�utii[�t off�mures (� �1Q.� �•� x �Xt9 �A . .�' � . . . ' , . . . _. � � ,:: , ]�Tn�t�'vf � (� $15 f�i! ,� x �t� �f} ;� . � . . . . . �� . , . , .�,;.�, . . . :. ,:t .b" -• t � .. • v . r ' Namb�t' of,��•� �i�.�3., � , x �5�p'�$. � �+'�J �} � ' ` , , . . . . , . . ... : . ��� �:� . 7�' . n • . ... ._�... .o �. ... �.e .��. � . .... .. .... ' ,, • �... . . .. ' .. . yy ��.' :�!)' >. " . .:•''1`rn . � � �. . :Y ' � 1 .� .� . .' , <. . . . .. . ..... . .. ...,: , . 7H[S fS AN APFLICATIOiV FOti A PERMiT-NG'[ VA�,xA t.R+fTEL PRtJ�ESSED t her�by ap}�ly #br a plumbing pamit and I acicnawl�clge that th� in�rrnation above is cc�mplets and accureta; i�ha� the wark w71 � n� aortfameuace with d�e �rd'enanccess �nd of ti�e City of �idley and wit�r tt� Minnegc� Constn�ctivn Cvdes; d��t t ur�tf�rsst�nd this cs` not a perm# but only s� &ppl�eatia�n far a it and w is nat t4 start wiit�c�ut e r with thc ved lan it� the oas� of alt rk w' u P��►it cro site; tfist the woric vwil� be in a�ccrord�ncs �F� P � iires review and apprv�+al of p s. } SIGNAEIiRB OF APPLICAAI'�' l3,�N'1' NAMIE �..'����'+�-h++.t��n � 7' '��� I � �..,�„t... .,,,.....,..r...-- -. _� _ --- - n° T� � — � `� City of F�ridley �uildKng Inspect�ans T)ep►artme�t 643�. IIniv�ty Awer�ue I'J�, F�i+dl�y, MN 55432 763-572-��04 ��: �+��-s��-a��'r�