P - 44455From: +763 428 6779 Page: 2!2 Date: 3/23/2010 8:31:29 AM
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Building LO��]�1 Y,rMIT Permit No.:� � l��-� (; �� _
Inspections ���Y���ATI:�I►N APP�YCA7'ION Received By.
763-572-3604 ��� n � �� .�O
CITY (:U]�' FRIDLEY �a d����-:,,
763-502-4977 iaX �rr-�r_rr�vE i-i-os �
AFFLICATION DATE:
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THIS APPLlCANT [S: d�HAULER � PROPERTY d'ti4�P:I:R
PROPERTY 0 W
JOB ADDRE55:
YOUR E-MA[I. ADDRESS:
MATERTAL TO BE HAULED: ��� I�,� �L �� __ ____
MATERIAL BEING HACiLED $Y: �I �= �� ��.5 rLiS A� _
DATES TU BE HP►ULED (UP rQ 3 DAYS)_ �
6
THIS PERMIT IS 1SSUED TO ALLOW AN INCRE.ASE OF AXLE WEIGrHT �'ROlV1 FOUIt (4} TONS PER
A�L TO FI�/E (5) TONS PER AXEL QVER'Tf�t 1?OLLC�WYNG riESYGNATED ROUTE:
�,�-s�" ..� �`�/
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N(ITICE: This permit is vaiid only far vehicles enro�.�te to consuuctian address during the hours of $:�0 am to
5:00 pm. See Resolution #01-2004 and State Statute aection 169.87
PERMIT M[JST BE ll�T VEHICLE w'ij[I:LE �TAULYNG ON ESTABLISHED ROUTE.
PE1tll�tiT I�: $25.00
TH1S 15 AN APPLlCAT10N FOR?. PHRMIT•NOT VnL[D (1NT[L PROCESSEi?
I herecby apply for a load limit modifcation pennit and t�kn�wledge that the information above is camplet� snd aauratt; that the
work will be in conformgnce with the ordinances and cod�s af the City of Fridtey- I understand rhis is not a pemiit but onty an
application far a permit and haulin� on icted roads is not ta :�tart without a permit.
SIC3NATURE OF APPLICANT �PCtCNT NAM� S�/'H �f7tT`L DA���/%�
APPItOVED BY DATE
COPIES GIVEN TO: ❑ POLICE C� �NtiINEERING
�'1� �Of FI'ldl@y �l
Suilding Insp�ctions Departmcnt �,
6431 University Av�n�e NE, Fridley, M�i 55432 �J
�63�772-3b04
FAK; 7�i3-502-4977