P - 39993From: 612 822 5408
Page: 2/2 Date: 9/15/2011 10:27:15 AM
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� Building PLiTNZBII'�IG
� ; Ynspections REi SIDENTIA�Y. A,PPLICATIUN
� ; 763-57Z-3604 �ITY �1F F�XiI,�Tl'
� : 763-502��977 �'AX E�:�c'rrvE�-�-zo�o
' STT� AbDRESS
THTS Al'PLICAN"T 151
' T'RO��,RTY
� O�RI
, � T�IVANT
SC JBM1T A GOPY p�
YOUR S'i'ATE
LICEN5E, $OND ANIy
CERTIFiCATE OF
IN5[TItANGE
YOUR GMA.CL ADDRFSS
t
❑ OWNER
P�c rro..
Received By:
A�.���-�
�•�u�il+� ���1r1 � Ywv7�L .f�7. .4l /'� � � 6rl/
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STATE LICENSC # �S% /' ''� E7�'P i�Ai"F, IZ
ST/a7'� BO1vD # OG % E3�+ DATE �I��%I /
ADDRISS:� � ��� rf �_CiTY .�%r%� zda�,�� STATE�.t�II'�
exorr��jy �z�- S`�q z— � �ax 95'2 ��3%~ I� ��
PERM1'�' TYi'� I !""°"'GLE FAMII.Y
TYPE UF WQRK: �❑ NEw
DETAiLED D�SC�iIPTiON QF WORK
❑ Tw0 FAMII.Y ❑ °rOwnrHOUSF
�er,ac�tsr
FEES ARE BASED ON 510.00 PER Ftx7'URE, EXCEpT Wi� NOTED. FDt7UtiE5: (II�TDICAT� TOTAT. NUMB�A 0� �ACIi $Fx.OV�. MtN1MUM FEE
$35.SD.
BAT�[ SINKR.AV _FLOOR DRAZAIS SIiOWLTt WATER PiPWG
_�A�� Gt1S PIPAIG (hI�ED CITY I,�Cj _ SWIMMIi*!G POUL WATER SOFTNER ($35)
_ CLt7THES W�T�f;lt K1TCI�N S1N2C WATER CLOSET BA�ICFLpvv PREV. (�15)
_pt��A�j� _LIUNURY'fiL4Y �A�'�3LHEATER(S35) FORfRRiGATiON
WAl'ER METER QTHER
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. . .. ............ .._....�..,.-.,,..-��—...�,.,..�,�. �-,�r,.,...,,,,�� �a�.��-�:..,n,�n��narr;�a,,.rra«.r•vaixu��5v� ",'�-�ar;ry.i,r.. -��.r.-v�rn��,���a,.��a���vi��.�'+w��::.....� �Mw•� .:u°-i
THIS [S AN APPLICATTON POT� A FERMiT-Np'I' VA,LID iJNTIL PROCESSED
I hereby apply for a plumbing permit and I acknowledge tk�at the information above is complete and accurate; that the wprk will be in
canformanc� with thc ordin�ces and eode;s of thc City pf Fridley &nd with thc Minnesota CO»shucti�n Codes; that I understan.ci ttus is
noI � petCnit but only an application Cor a pcstnit and wor�C is not t4 Sttut without a permit Om Site; that the work wil] l�e '� acCOrdazlCe
rr+il:lx the &pprovcd plan in t�e c all wh�i -r�qui�es rzvizw �nd a ro}�-�fplacts. / %�j /
STGNA'i'Ufi,EpFAPPLICANT _ ������,,.-''" PRiNI'NnMT�' /.cL. .1 %/_ , �.-,, narF -! ���`�
City of �ridl�y
Bui�ding �raspections Department
b431 C.Tniversity Avenue NE, �'ridley, �T 55432
7fi3-572-36p4
FfiX: 763-502-4977
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