P - 42115From: 61 2 822 5408 Page: 4/4 Date: 10/6/2011 10:39:45 AM
� �if��
Bui�dzz�g
InspectiQns
�6�-s7z,3�aa
763-502-4�77 FAX
���� �Z����� f�o ������
PLiTNZBYNG
RE�IDEN'I'Y.t�� .A,�'PLICATIOl�T
CITY OF �'Rx�LEY
DATE YOUR E-MA1L ADDRF,$$
STT'E AIIDItESS � /'i�. 4 I'L
THiS API'LIGANT CS: O OWNE1t �dN'f12AG7'OR
OW1Y�'W
TE1VAi�T�'
SUBMf!' A COp'Y +OF - -- ---� `-.—
YdU�. �i'ATF STA'f� LIC�se �
LICENSE, BU1MD AND STATH ii{d'N� fP _
GER17FICln'T� O3� �►nDR�SS:�
IDtsvl�ntvcE �ro� /`�t�.-
PERNIIT TYI'E � �Irtt�LE RAMir,Y
'Z"!'P� OF'WORI�: � � rt�w
DETAiLED DESCRIpTYO1V f?F
�
a �rwo �n�.Y
r�x�c�rn•
.a
. ..�
Pe.cmut �To `�L�
Rece�ved ay:=
9g,ate�4�ec�� �
_� EXP DATE
Ei� Dn7E
GTi'Y �r:r�.%f.�
��x ��Z � `�'
❑ �r,wr�ous�
��
�S ARE BA$ED ON T10.00 PBRTIX'fUItE, EXCEPT WHERE NOfED. FIXTURFSc (WDiCA'i'�'fOTAL NUA3BER OP EAGH 8�i.0!VI�. MINIMUM FEE
S35.i�i.
BATH S1NKlI.AV �FLOC)R DRAiNS ST�iOYV�R WA1ER PIPItY�i
— Ba�� c�s �,nvG (rrEm crt�r �,IC� - swuncvurrc pvot — wn�x sam'r�R l�3s)
_GL,OTHESWA3I�It K1TCT�'.NSINK 1NATERC�-Q:ET BACiCFLQWPJ�V,(;13)
_ DI$NWAS�iER _ �.AUNDRYTItAY �ATSR HEATi?R {S3S) i�flR TRR1CiATiON
� WATER. METF,R �0'�'fi�R
i 31 i,, `�! Sir�,�*' '$""fF ' flN . , ,� �. z� ,��,,;,;;,;a�, v d tgl4lu' ^,F - trg � � q� - rwl + r-�'� ,
7 e-; � s k� �, � �i a i, a�, � t,�,,.' N1 w 6 w� �
a � �'"c=; �� � G a -A �r 4 � lr� v ' ,�, 6 �i
' � '' �7, iY � 4�t n � <� M x 4 r � '�' �� r;�r � e ���'Y„4 ,�y.r,� � Iro
� �' ti �.{`�V,.': ,�,,..,•�;� 4''t�.r ar��8 =•`�„�,� � p . l�l�;�;r�(ntf14��� :;;i,4c. ..� ' � j� 1 l�fn�� � �.;;ti�,' 1 +f_
� THIS 1S AN APPLI ATIpN FOR A PERMIf•NOT VAI.ID �JI�TIL PxdCESSED
� I hereby apply for a pl�unbinS perrr�it altd I aeknowir.dgo that tlic information above xs cozliplete and �ccurate; tbat tb:e work will 6e in
conformancc with thc ordinances a►td code Che City Fridlcy and witli tl�e Mi,nnesota Construction Codes; d��.# I understand this is
� not a permit but only an a�pl;cation for a er�u • d o is not to start wat�out a permit on site; that the work will be in accordance
' wilh the approvcd plan in tlte c�seTif ll whi � ucs review and app�•o� f lans. / f� �// l
i SrGNATIJRE OF APPLICaN�r �r N.anaE /a��e.4 �J.te.r�u pA'T� �
� City of F'�-id�ey
� Building Ynspections Aepart�meat
! &431 University Avenue NE, Fridley, MN 55432
. 7b3-572-3604
�AX: 7b3-5�2-4977
� ..._.- ---••- --.... .. . ..... _ _.... .._.__.��__ __... . .. .... ... _...--• - •••---.._ . _._.—. _ . _.