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P - 48663
1NML121420 Builcling IriSpeCt'tc�ns 763-572-364� 763�SU2-4971 FAX ► � � � 4 fi � � � � i! ' 1 P�rimit . . - . : ' ii�/►.�� , .� � : � r � ': -, � • UATE 4-17-12 YOiT1LE£-IwtAtLAUI7RESS � __,. 5i'CE ADDRESS __751 PANDORA DRNE FRIDLEY,MN,55A32 THi�AFPLICANT75€ CIOWNER x ICflNTRtSC7`(�R �"��#"��l � NAME: DONALD CARLSON ���� �p���; 751 PANDORA DRIVE FRIDLEY �'�NA1�'I` C['l'1' S"CATEMN ��p55432 pH���; 763-571-3796 �-�� � �t> i �� NAME. UNNSTAR TRANSFER SLIAMIT A COPI' ()F gTATE LiCE1�iSE # 063901-PM Y4UR STATE EXP D�'rE LtCENSE, BOM? Ah@ STATE BOND # _. .�_ IXP DATE CERTfPICATE QF' qpp��5. 9995 W 69TH ST Gp��y VINTON STATE IA yiP 55432 IT�i�uil`EtANCE p��� 651-633-7621 FAX PE�YtiT TYP'E � iA X ; 31NCi[:E FAMTLY . C1 TWO �AMiLY CI T{}WN�iOt3SE X �r�;ac��rrF DETA[LEi� DESCRC�"TiC}N t7� W(?RK REPLACE DISHWASHER FEES ARE BASEU i7I� $ td.OU PER FIX7URE, �XC�'1' WtiEitE NO'I�D, FIXT'URESi (RttT}IGATE TOTAL NUMHEit {�F FACR BEL4'Vt?�. tvflNtMUM FEE $35.Sp, �ATH SI13K/LAV Fi.Ot3R FiRAlNS _ SHG1W£Ei WATER PII'ING — sn-rrfrcra �"" �AS rrnrrr� ttv�� �z�°�t c.�e> sw��ttrac �t, "` w�r�tt s€�F'rrr�� {as�� ^ c�.o�s wasx�� ° K�rc� s��c = wn�a� et.as�r �$nc�r.ow er�v. tsrs� 1 I}ISHWASHER � C,A[TNURY T'1�AY' WATERIiEt�T'�R ($3S) FOIt IRRTGATiQN ,�'WATER ME1"Et� T, pTHER. 'T'fiIS [S AAI APPLICATICI2�1 F herebY �PPIy fctr a plumbin� p�rmit and i acRi�c�r co�forrnance �ith the ordin�nces �nd cocies of the ncrt a permit but<on1Y ari apAlication fcar a:pe�nit a vv�th �e appta�+e€! plan in the e�s� tif �t1 wo�jcyri�ic A PERMIT-Nt7T VAL[CJ t)NTIL PItdCG5�kkt} hae th� it�formstic��s abave is compiet� and accurate; that tihe work wiil be ir► Fridley and with the Minn�sota Construcfian C�sdes; zhat I und�rstazsd t�iis is : 3s r�crt to stert witk�out a pe�rmit an sxte; that the wcurk will be in ��ordaryce %����re 'cr� xnd apprcr�v�1 csf plans. NANF� CHARLES GA6RELCIK �� 4-17-12 DATE�-.7��e�i %� �City of Fridle� Bui ' � �nsg+ectic�n� I7►e�artment 6��3 i U�i�ersity Av�nu� 1�+1E, �'ridley, MN 55432 7G3-572-3604 FA�: 763-�02-49fi'7 40.00