Loading...
P - 60291� �.Sl ��� �L11�C�X�� Inspec�ions 763�572-3�04 763-�02-497� F�lX DATTx -a'`� r'�i Irl r �r� S1TE hDDRE33 �� '1'tliS APPLTC.�nrr iS; From: 612 822 5408 Page: 2!2 Date: 4/2l2012 8:49:13 AM � p�,.�,� sc.� � �'..-+-'7 � .� . �������� ��SYDENTIAL A���,ICATY4N CIT'� UF FRiDLEY '�e.�.; cc�;- ❑ OWNER YdUR L-MAII. Al7DRES5 c � /�s � ,�CON'FftACTOR �� Permit No.t�� Received By� � �t'fY D�.�'�g' . awrrE�v Y � � TFNANT •4D6RE.S.R: G�( 1 ►ni ,�� � �,..���. . / ir/ CirY Y�., STA'F6�"'�Z1P S' S�'3� rHOr�: 7�� �-� 3 g- �s 4 6� N'i'A'AC'TI]R .,...�. ♦r_. _ 1_ � � _ . • � � l i _ . .e � � �^ � l � _ d � � � .. :.r�....�+.µ—c. - - SUAMTF A COPX OF STATE L[C�Nfi�k G.f .� f�% �.r�7 6Xr n�� YUUR 3TATC LtCr;NS�, IiOND AiV� .5'PATF. RQND !t �[�� �� L•xP DATC c�nr�cn�r�or• nnD�ss:��.�/ �t/' �.��' s� ,_crrv .�""i.�l 5 STATP/�i�'T,tP �svir INSURANCE YHC7NH(n F�- `� f' 3�- S.� �l,�r�' `� FAX �ERMIi� i�XPE I ��GLE FhMILY TYPE O� WORTC: I❑ N�w ❑ �iwp Fanni�,Y ❑ TOWNiIOUS� �f'R.EPLACkMtiN'1' DE3'ATLED DESC�IP't1bN OF WORK � p r�.rr���^ t�r.y�°.•,�Cs'-!-��{ ��- � ,., �. . . I'ITS AR� DASELION $1tl,U01'F[t �'IXTUIii, �XCiPT WHERE NQTE.,D, FIJ�TLtliES: (INDICATE T(7"fAL NUMklER OF �ACH k3�LOW). MINIMUM FRP. �35.50: SATH SINKR.AV FbU(7Fi aRA1NS SHnW�R WA7'�R r�P[NG BnTH'itlB GaS PIPTt�I� (NI';�D CCtY LlC} ^ tiwIMMING POOL WAT�R SOTThTL�.R (�5) �LOTI�S WASIIEk KLTCI•II;N SIMC WATEIt CLOSL"•T BACKPLOW F+R�Y. ($15) , U[SHWASH�R _LAUNU[tY'I'ItAY _WATER H�A'I'�R ('�35) Ff)R IRR!(�rA'1'ICjN WATFR MET€R '� � OTEIER �{�� ,�u,� •. r.� � �� �f" Y! � ,At „ i n �! fl y '• ��!��Iti� 7, ,� � „,� �t U�;� ; ,�i� ��� � ,+a , � t i a���, ., ; i i;�+ �1fY`i' ft°,�� �u �� �, i'; �' � � �„� } � �+i "'t C��{�� h�i iN` ; � t i SiP� t ��t'S}�'�N �i�� }� +:R�� ��4,1�, f �� f#'#�i 't�'i�� �1� i3i�'� �jp�� t + « � � ��IPy��1j��k a f' ' , { � ;��5° � . . . a '� �i ' � . �w ��� ` '� � f � a� .�, �4 {, �� , ,I ,.; �' ,t�;�ut;; , �� �rF M,tu t,��,,,;,, , ,., , . . . . ' � ' "?.��,�,��r� Num e'r a�f�i�i:�,s f�'Sr�;O dlI �,..+1� �l:��^,�I Q -;.�, .� � ,•{'ak+ ��� � �:} a�,3? iE faat�l��!`.@t �5.d. " : ".3 ., ,�} n� � 9t �i,��i� tii'i���,,� ,�'.� e RLIl�1�Y tJ�'�%±IY � �t'��. � �� DI1� �;iE1� ���Mj� � "., . . ' i�', •:;�w17 i u��h� s�f � 1 ,�y, t� ��� �,, , �,,,, �,r �t �N �, •i �.:u.......:,�:`t'H:.� '+rM� ����.R ''''!�%jl,a?4dtk:di,:., . � i �1 ��• i�r � � +' . �lt��t� 7 7 �,� i�� 1�,'' ". .. . '��1q '{�ua: 1� i�j �jti}'i . t` �uµ ' ifii t'�ts{'!�!.d � rH`��Ifit�t 1.'� . .. 4 "}u '� d ',�{ { �}P;r'pfINNlt.slli 1'f1i •.^�� �'��t`iiuVk r'+.1?�r i tj'n�`(�i�{1ifPieR'�.'iii +: i?.�� ; ;' ., x � .. - ��c—�r7j � ��c7.. � ,� , .��. ..+a.vt! , ny"'."'r_i.;;,, � `i '� : � �';.`y° '1"� .np, .�, �i �w� . ;•.;.. ., ;:�'' '•y�:�, x:.,r.; nr �� u ..,r � � � ':.;�� { L�'�� t :.',`' � 'r:-. • ,.;� .' �,.k�f�b1,.:: � �ww', i.� '};3'i�' �," M'4� ::: �• •.t ? , . , � ..: � �� �;r "'„�^� 1 b ��: � t� ; i �i;, �;r �•,< �x �'��n,x`,��; ` i � a, ' s��,: . .��# , � ��� , ..� ':;:: • .{ , ;•..; 1�1J1�1�lwl '1Yl'$41R � . :�: �� , � =r�t��h�t,�• �.�,: �* , , �,�;R� , r�+�'Si�t�.�.: ;�a,����',j,;>''�,; � ,�:� � ¢t .r?s�„ THi5 lS AN APPI.iCATION PORA P�RMTT-NO'l� vAUD UN'Pll. PRUCFSSFn I hcrchy apply for a plufr►bin$ petmit a�id I acknowledse tltat the information abovc is camplete and accurate; that the wock wijl be it1 confprmanC� with t;he ordi�lane�s and codes of the City of Fridlty s�nd witli the Minnesota Construction Codes; tl�at I understpnd this is not a pertnit buti only xn application f� rmit work is ncrt to 5t�et without s permit on sit�; thAt the wurk witl be in accardanoe with thc spprovcd plan in the ease of �11 work ':h r quires revizw and approval of lans. ` 3IGNA7UR� 4!' ANk�LlC:ANT -.�'"�1- P�� �d s-���' ' llA'1'b� �� (.�,: . - `---_.,... . __•^----'----- ----' — _ .4.c_G�..-...., .� _ �I� O'� Fri(i��y uildin„ Ins�rectians Department G431 University Av�n�ie NE, Fridley, .MN 554�2 763-572-3604 FAX: 7b3-502�4977 � � �