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P - 44849From: 6128610269 Page: 2/3 Date: 10/4/2010 12:30:52 PM �UI.�C�� Y..�M�� Perrnit No.: , , m �; l, � - . , ��spectians �tESIDE�TT'IAL .APP�ICA►TIU1� �t� �a��,y:� ��,'�;�� 763-572-3�04 � �, . � �� CCJ IU ��-so2-��r� �,�x ��`Y Ok' �'RID�.EY �� e� a. EkF�CT1VE 7�a-201� DATib�i ;' � 1 t� YOilR Tr�.A.II ADDR�SS ��'�'t V►qttu. �� ►JY/�n� G� ��►t �►'►�. STFE ADDRESS 1 Z i 0 �_�]!�r i�{-� � �knS APPLtC.A.N'� [S: ❑ QWNEK �ON'LRACT4R P�t.U�"E�RTY Np�:_ C� J ry h ��' O�TER/ ADDR�SS: � 2 7 0�' ('n�r�Vy, fiu.. N.. !' C7TY ` ST,AT6 � — 7�NA]VT �HOZV�: C:U�YT�tAGTOR 1+tA�: � S[7�� A COP'i� O� s�.�'�'� �„�C�SE # �,S � 2. S PY� _ . Exp D��E 12 �� I(� Yaii�i S�'A7k a.xc�s& �n a�n sr,�� +� � 319 �fG t7 �- 9 w!,5'Gv�i � n.nrs GE,R7IFICA'f� O�' ,�„�s. � o c�xX�e_ s�r,��,�ZIP�P� ik�IS[3�:ANCE PI�iO� �Q �� ` �0� � �7� � f�,$ �r,�}� �� _ +�' � ,. Q � � PERMT�' '�'Xk� 0 SIIdGL.B �',�l�i Y � FAMILX C3 'I'OWNHiOt7SH 1CXPE vF w01�K; � �' �i�rx.�,cr�'r n�rAn,�a ��o� o� wox�c �1��-�,��a�� tcr�- .t.k,�.�,�.�t � � te.�.�..�....�e 1� 5��.� F�S ARE BAAS�sA CJN S] 0.00 PER �7UR� �tCEPT wki� t�0'!`ED. FU%�U�S: (3NDiCA'tE'1'+D�.AI. TVLItNBER OF �A,CH aEt.Uw�. .M�NI.lvIUM FEE S35.SU. B,A,I'ii S1NKlL�AV _F�.00R DRAINS SHQWisR � WA� x'[P�NC BATECN� CxAS PIEIftG (NE�i7 C�'X LiC) SW[iv[l�mvG �OOf. _ WATER S�'NER (S35) Cx.O'�3iES 1A�ASHE�t K1TC�V StNK WA'�t, CI,OS�'1' _BA(��W PR�V. (S1� j,1�,5k�WASHEK `LAGRJ�R,Y TRAY WA'�R �EATER (E35j F�L�ICiATTON WATER Mb'TER _, OTHER rrwn� o� �� $ia.00�. . ` . �� io.00 � �'. � � � � . � . � . , . : . Nut�ber of fixdues (a� �15.00 _ . _ x �i� 5.Q0 = � . . , . .Nuin�ber of � (a� 535.00 _ __ x �3s.OQ = �' _ _ ' , ' ' � .. . , � . ' Stats Su�rgt ' . '' . . , : � $�� .. .. : , • .' : • . . 5�0.01! . � � � � . � i'ota! = S . . � . � , � . T�51S AN APPLIGe4TI0�► FOR A PER�i1�'-NO�' VALID UNTIL P�'iOC�SSED I hereby �pp�v for a pfum�biu�g pczmit and I aclazowSedge that t�e information above is complete and ac�urate; that the work. will be iu� cot�fac�»ct with Ehe o�ctinances and cades o�'t1�e City of F�dxey and with tl� M.ituxesota Caxa�truct�ioa Cod�s; thst ] ux�derscand this is nat a�i� but a�ly an a�pLic�ti�'► �r a�ermit and woz�c is not to start wxthout a�i# a� site; thaE the wark wi11 be in acca!ldaxice with d�e ap�Zroved pkan in th �e o�1 � whicf� requiu�as teview axad approval F�lans. ��} 3lC3�1A71JJtE�APPI.I(:A.N'1�' � �' PF31�iTNAM��w'�'P Iw1? NI°!� APPROVA,�. II«19P�C1'ORS SICi�i PLFAS� NQ�: sEPARATE � RE .�U�FOR �U�LD�iG C'�'.�e.�L.AND CAi: vYQ�.K. �. City ai k'ridley Build�g Inspe,ctio�us D�partment 6431 University .A,venue NE, �zidley, MN 55432 7�3-572-3604 FAX: ?63-502-4977