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Building ' PLUMBINGr Permit No.: �
Inspections - �SjIDENTIAL APPLICATION Received By:
763-572-3604 '; CITY OF FRIDLE� Date��: 0
DATE U� (�/ YOUR E-MAIL ADDRESS
SfTEADDRESS Sawtt a�.S 0`•_�wt
THISAPPLICANTIS: ❑OWNER � �ONTRACTOR Abdalla0mar
1378 Meadowmoor Drive
PROPERTY Na�tE: Fridley, MN 55432
�W�� ADDRESS: 7634326025
TENANT � � Z�
• PHONE:
CONTRACTOR NqME: "
SUBMIT A CpPY OF STATE LICENSE # ' C> EXP DATE
YOUR STATE ADDRESS• f^� � C1TY �' ! /t STATE��LIP ��Y�
LICENSE WITH . PHONE - y0,3 FAX Co 1 $� 7" B I Z
APPLICATION � �
PERMIT' TYPE �SINGLE FAMILY � ❑ TWO FAMILY - Cl TOWNHOUSE
�
f � � �
TYPE OF WORK: � �W �I ��pLACEMENT �
DETAILED DESCRIPTION OF WORK
�
� PER MS 16B.665 the permit fee is a minim m of $15.00 or 5% of the total cost up to $500.00; whichever is greater, for the
: improvement, installation or replacement of�¢ residential fixture, excluding the fixtures. (This.shouldrsflect only.the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
i
'��ROR�ROJECT'•5 WHERE LABOR EXCEEDS•�UO;�ES ARE BASED ON $10.00 PER FIXTURE, EXCEPT VJ:I3ERE�AIi'�T:�II..:AiCTi�R£�:..(�DICA,TE TQTAL
NUMBER OF EACH BELOVi� .
BATH SINK/LAV FLAOR DRAINS SHOWER WATER PIPING
BATHTUB GAS PIPING �v�ocrrrucExsE) r SWIMMING POOL WATER SOFTNER ($35)
`CLOTHES'WASHER TCITCHEN SINK � WATER CIASET BACKFLOW PREV. ($IS)
_,DISHWASHER _-LAUNDRY TRAY �WATER HEATER ($35) FOR IRRIGATION
WATER METER r OTHER
Permit Fee $ ' Number of fixtures @$10.00 x$10.00 =$
Surchar e '.50 Number of fixtures Q$15.00 x$15,U0 =$
TOTAL DUE $ Number of fixtures @$35.00 � x$35.00 =$ 3S Oo
. . . ' , State Surchazge = $ S"�'
.
Total = $ �
THIS IS AN APPLICATION FOR A PERMiT-NOT VALID UNTIL PROCESSED '
I hereby apply for a building permit and I alcknowledge that the information above is complete and accurate; that the work wYll be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an applic ' n for a permit and work is not to start without a perrnit; that the work will be in accordance with the
approved plan in the case 1 o w' � uires review and approval of plans.
' 1 ��/ <<i�a l�
SIGNATURE OF APPLICANT PRINT NAME J� NO/i0I0 AATE I
'� City of Fridley
uilding Inspections Department
6431 , niversity Avenue NE, �ridley, MN 55432
� 763-572-3604
' FAX: 763-502-4977