P - 44962Building
Inspections
763-572-3604
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
DATE YOUR E-MAIL ADDRESS
SITE ADDRESS Se►wtL ea.S �w�er�/' �
THIS APPLICANT IS: ❑ OWNER �CONTRAC Sandi Heroux
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH ,
APPLICATION
PERMIT TYPE
TYPE OF WORK:
6434 Riverview Terrace Northea
N'�` Fridley, MN 55432
ADDRESS: 7635718152
PHONE:
NAME: or.�� .n �u�rJb
STATE LICENSE #_ SC>S�
PHONE f (� / Z^ )T Z % –
�SINGLE FAMILY
❑ NEW '
DETAILED DESCRIPTION OF WORK
❑ TWO FAMILY
� EXP DATE
CITY �'
FAX �'
- 0 TOWNHOUSE
�REPLACEMENT
Permit No.:
Received By:!
��';�� U
STATE ZIP
201
ATE�GIP S�Y
� PER MS 16B.665 the permit fee is a minimum of S1S.00 or 5% of the total cost up to $500.00; whichever is greater, for the
: impro�ement, installation or replacement of a residential fixture, excluding the fixtures. (This.shoul�rBflect only.the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $SUO = cost of labor x.OS =
�ROR:�ROJECI'S V+�RE L,4BOR EXCEEDS�$500;�'EES ARE BASED ON $10.00 PER FIXTURE,�EXCEP`f F�VHEREPC2'f:ED..:R[�S: .(INDIGATE TO�TAL
NUMBER OF EACH BEIAV� �
' ----
_ BATH SINIULAV_.-- --_ _ _FLOOR DRAtNS_ _ _ __ -- - - _ SHOVJER __ _ _____ --- —� WATER PIPING
BATHTUB GAS PiPING nv�oc��rucenrsE) SWIMMING POOL WATER SOFTNER (S35)
CLOT[�S WASHER KITCHEN SINK WATER CLOSET � BACKFLOW PREV. ($1�
„DISHWASHER _-LAUNDRY TRAY LWATER iiiATER ($35) FOR IRRIGATION
„^ WATER METER ` OTHER
Permit Fee $ Nutriber of fixtures @$10.00 x$10.00 =$
Surcharge .50 Number of fixtures @$15.00 x$15:A0 =$
iTAL DUE $� Number of fixtures @$35.00 � x$35.00 =$ 3S.Oo
, State Surcharge = $ S.t �
Total = $
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED '
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work w911 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 applic " n for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case 1 o w" r uires review and approval of pIans.
SIGNATURE OF APPLICANT PRINT NAME J� NO/D/Oi'i''% DATE O
City of Fridley
Building Ins�ections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-49?7