P - 44435Building
Inspections
763-572-3604
763-502-4977 FAX
DA� � 23 -?�1�
SIT'EADDRESS I� l
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
CERTIFICATE OF
INSURANCE
PERMIT TYPE
TYPE OF WORK:
NAME:
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2010
❑ OWNER
YOUR E-MAIL ADDRESS
Permit No.: �
n
Received By:_�
� R���
l�/ll'�'%�J ��t/p �
T�?v�-
ADDRESS: CITY STATE ZIP
PHONE: ?G 3 �' S¢`-� ��QO
NAME: Klamm Mechanical Contractors � �� �'�
STATE LICENSE # 12409 County Road 11 ? DATE /"�Ti"".�/'t���
sTa� BorrD # Burnsville, MN 55337 ' DA�
ADDRESS: CITY STATE ZIP
PHONE � �j Z .�S � O ��E� �S FAX�c� Z � � �`J T Z � �
�SINGLE FAMILY
❑ NEW
❑ TWO FAMILY ❑ TOWNHOUSE
�ijREPLACEMENT
DETAILED DESCRII'TION OF WORK �/L�.� ��O/,►/Z S' /�� T`it'�/ -5� `�/�
�o �� %I — / `n/ f9 �.G✓ �t �!, i l,
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
BATH SINK/LAV _FLOOR DRAINS SHOWER
BATHTUB GAS PIPING (NEED CITY LIC) SWIMMING POOL
CLOTHES WASHER �KITCHEN SINK WATER CLOSET
#DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35)
_ WATER METER
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID iTNTIL PROCESSED
WATER PIPING
WATER SOFTNER ($35)
BACKFLOW PREV. ($15)
FOR IRRIGATION
OTHER
I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will 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 application for a permit and work is not to start without a permit on site; that the work will be in accordance
with the approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT ��/�� PRINT NAME ����L?s1t i'K DATE � �� �d
_ /
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977 ..�-