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P - 43042$uxXdirig Znspections 763-572-36U4 763-502-497� FA� From: 7637834566 Page: 2/2 Date: 10/10J2011 3:08:31 PM PL��SIN� P��xt �vo. RES�DENTIA.L APPL�C,A,T�ON �ITY UF �'�DLEY �eceived By_ � �-..,. � z��,7c� t t�—i C�� 61 YouR E-�arr. AApit�'SS �,'.�r i t�aso,-, � i k'1�r��t`c:.��c�r► , tao� st� n���ss 8c��'�. �, c�k� S�. Z� TE�S AkPLICANT I3: ❑ OWNER OW�+R1 I ADAItE35: �1'a�'t�.�, �ao`'L'1r'� �,1r i� � TT�I,A�,V7.' PH�I�; '-l.Ce3.. �4'-'7'i- c�r'�� i �'' if"�e�— STAY'E�ilk SU�M�' A, COpi� ()F S7ATE LIChTiS� #` E7�p A,t1'x'� YQU� S�A� T.iCENSL, BOivA � 3'�A'iE HONtI �i EXP DA7Ts c��t�rz�tc,�� �� a�n�sss: ��-rc� k�t�,� t-.� t� czzx _'�1��, srAx�s r�► „r'�,,zrn��� f�1�� f'�ywA� ._ o AA7�VAtl+7���.�.." ��taNE�T_�'��Ya� �"�'�4�^, FA3C'�a�����.-a.�.tii�� PEItMIT TY�� � �szrrGL�s �,n�U�.Y �'xa�� oF wa�: I °1�''' G7 �t+4 �,AM[LY O xOWNHt}t15F. i���n,c�ua�rr 1.i.L.' l iIILLL ��iJi..� A A�A� Qr vY �M . � a t-tii . .. � a �,n..s ..,` _ � �... �.r/"e—��Jl_. ..._ PER NXS �6�.665 the petmit fee �S a Au�ounum of SI3.U0 or 5°!o af the total cos# up to �00.00, wh�cb,ever is �reater, far t�e ;i�;provem�nt, instalKatipq or z�eplacemeat ofa ares�de�tial fixture, �rcc�ud�,g the fixtures. ('I'bus shovId reflect only the cost o�labcrr } L.abdr east �nder $3�3 � $15.00. Labor cast betwecn �300 to $SUO = cost o�' labor x .OS = � ___ �ius .3� surchaz;ge . O�i. Ft31t PROI�EC7S WFIERE LASOR EJ{C�bA3 S50Q, k'�ES ARE DASED ON S 10.00 PER FiXTUR�, EXC�PT WHfiRfi N��'kA. F17�7`URE3:- (FND[GAx'E 7Y37`A1. MJI�i��� 0�' �A,CH �EL�W). MINiI�UIv� PF� $15.50. _ bA'TFi SINK/L�4Y pLf�R DRAiN5 _ SHOW��i _, WA'i'&� P'IRIAiG _ F3ATi�'CU8 ,_ GAS PiP1NG (11�A Ct'�X I.iC) _ SiNkIv�N6 PO�L _ WA7ER. SOF'i�TF,.tt ($35j CLCITHES WASkI�;R ,_ KilY:til:'N STNIC WATER CL03ET _, SAC�CS�O� �V. (SIS) _ AxS�!'�VAS1iER w,� LAUNX3RY TRAY �WATSkt t��'Fit F�35) FOx 1CCRtGAT10N ,,,,,,,,, �ATER h!lETER � O'ff� �t Fee $ Number of �ixt�res @ S� Q.tlt> _,,, x 5� 0.40 = hsr�e .30 �Turnber of fuctures �$ X5.0� x$15.00 = laU� � ox Nwr�:n�r offix��res (� $35.oa � x$35.� - 'x'�s �s arr aprraca�c�rt �c �. ��e��-xvr v.qt.tn tn�a, �e�tocr•ssEn � hereby apply fot a ptutxiibiu�g �e1CZ��it and I acicrtovuledge that tb,e information above �s ccrzz�plote and accuzate; chat t1Ye wc►rk wi� b�in cvrnfo�nnac�ce with t,ht ordinances and eodes oftk�e City of Fridley and wlth The Miurtnesoffi Consiructiot2 C�IeS; t}�at I urlderstsnd th.�s #s nc,t a permit but only a� app _. fc�r a it and wozk i� not to start w�thout a p�rmit aa site; that tk�e wo�c will be in accor�ce wift� tkte approved g!� al� w��v�ich�e�ires t�view az�d agprov�l oij�Ia�ts. r SIGNATU� Ok +4�1'LICANT A��'$OVED BY �i� Of �'X'li���jr �ui��diva;g Znspections I�epartmen# 643 Z Unxversity Avenue �, �rxdley, MN 55432 7fi3-572-3�iU4 FAX: 7b3=5(#2-�977 Ae1.'l'E