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P - 35744B�ilding Inspections 763-572-3b04 763-502-497'7 FAX PLUMBING RESIDEN'I'IAL APPLICATION CITY 4F �`RIDLEY �FrECTrvE i-�-zoi i Permit Nfl.: Received By: Date Rec' DA'CE a' l' I I YpUR E-MA[L ADDRES$ V si�Ann�s.,(.�...�`� �e �. ��,�� T1�US APPLiCANT IS' ❑ OWNh1t �ONTRd1CTQR OWN�RI TENANT S�JBMIT' A CQPY DF YCaLiR STATE LICENSE, B4ND ANi) c���zc�� o� m�s�,�xxxr�c� 1'ERMIT TYPE TYP� QF'VVQI� � %IrZ.°`L�Ci19 EXP �A7'E sr,a��u 7vt�a,3� c{�'rr �nn� AnnR�ss: 7�� (���r�-/—y,��✓� c��-^rl�i,e( �� srar�+t1' z��'.� PHOTIE /'��P�"� ��- a7o�.ti FAX %iv.� - �� �-�5 � �Si1Wf'xI.E FAMILY � DETAILEI3 DESGRIFT'IUI�i O� 11VU�K ❑ TWC} FAI�IfLY D T(i�'NHf3t1SE �€tk�'LACEMF..NT �s n�E e�ns� or� s�o:oa �� t-�xz1; �E, s�c+e�r w►-te� r�r�T�.a. r•ix��s: nh�aicA� Tara� n� un�z� oF �neri �a�.c� �ir��n��an� � �s.sa en�� sur�,v FLfXlR� Df�lAAINS SF)G31�YER wa� ��rac BA"fEFi'tJB (iAS P1PtNG (I�EED CifY Ll� T5W7Mb1I1VG P�OI. �WA3�R 3()P'fNER(S3r� � cf,o�s �vASt� � ICTFCHEN SIMC � WA'fE.it CL(}SEI" _ BA�KI'LC1W RR�. (� 13'� _,_, DISHWASHER � LAUND[LY TRAY �WATER HEA"i'ER (335) FOt� IRRIGATIQN WATEFt AAiTER tkTft�R l+ius�ber of 6ar,Wr�es �a Sli}:4U x$IU.UQ �� I3umber af fixtures ��13:00 x� 15.Q0 =$ Num�r of #�xiures Q, �35.00 ,.,� x�35.Q� �$ 5: C,� �? Statre Su�+ch�uge $+,�.,,5 O�ti _ � �9 . 4Cb THlS iS Afil ARPLTCA'f'ION FUI� A PERhtIT-TVOT VALlD UN7I�. P'RUGESS€i) � he�Ery xp�1y fur a plur►�ibing permii and' I actcncw�+t�edge that the information abrn�e is complete anci �oc�rate: tlmt t� w�urrk �ilE be ir� confc�nance with the ardit�te�s and cod�s a Cirty Fridley and �v�th tl�e 1�Iinr�c�ta Cc�r�tction C�ts; t�tat I t�� this �x not a perm�# b� onfy an applicatio� for a pennit rk is nc�t to s�art without a pe�tit on sif�. that the work wi�l be �rn danoe with � approvcd ptan in ea�e af al( worfe whi uu�es revi�v ac�d a val of plans. s���a�� �,�rri.tcar�r rnrr rrn��C h a. r I,.o s�E'� :� r�,�� - „� City of �ridley �din� Ins�ctians �.lepartm+�t 6431 Univ�rsity Avenue NE, Fcidley, A+IN SS432 763-�72-35(?4 F�4X: 7�3-502-49"�? . A�Wd 65�EL�6 LGQZfZ18:a}eQ y/Z :aB�d t�56'981£9L :uao�� ����,"� � �� � „ � , *.� cx:.,, ,