P - 84376Building
Inspecti�ns
763-572-3fiO4
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PLIJMBING
RESID�NT`IAL APPLIC'ATIQN
CITY OF FRIDLEY
EF'F'ECTIVE 1-1-2U12
����t No..
Received $y�
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Df�-rc 10/26/12 _� ��c��:RE-tiL��r.,aDDx�s� wnelson(a�larsonplurnbinc�.cam
s17e.�nnxESs 7.624 St�nso.[1. Blvd....NE.. _ __
_ . . _ _ � . ._._
T}IIS APPL(C.ANT IS'�� ❑ OWT�ER I�SCC?NTItACTUR
rrcvrGrc i r � ��AA9E_
��'�`��� ' n��RESS: __7624,,St�,nson Blvd N;E,. cir� Fridley ��r.aTE,�z�r�55432.
TENANT _ . _.._..
rHt�NE 763 784 5595 �
�.........
CONTRACTOR ,� ;,,:,�,,�E. Larson Plumbing, Inc.
Sl.JL3N1I'l� A COPY O}'' l��TATCLICENSE tl x_y.P�i�'34.�%.3� __,_,�_,...___� �E�CI''DATE �2�3�j�.3
����!ri s���A rF: i - - _ .�.._____..__�..__W._._..
�.�t:�;NSE.. tiov�.4tv» � s�r:a-rr:BC��vu# kVIB3613 '�:xrr�ATE 08113/12
. �._.....�.�� ... _ .���.��......��.
cF.��r�}�cn�t�F: or AnnRFS,�;,,�,, 3095 1fi2nd Lane NW c�TV Andover s-�A-�-F MN z,r 55304
INSURA�C'F: PE�ONE .....v_v%63-�2% ZG$O F�X %G�-42%-9�S
PERMtT TYPE
TYPE UF WQRKt
�SINiiLEffiM11_:Y ❑'I'W()FAVi1LY
❑'.VEW
UE:`1:41LEI3 DE5�KIP'I'I()N OF W{7RK
�I REPLACEMENT
e Water Neater
❑ "fC)lk'NHC)USE
_..._ — - __ .� .. . --. �_��_ _ �. � . _. _.�.. ..... __ ._ .._.. . __ .___-
rEES ARL IIASED ()N � 1U.00 PER rIXTL'}tL. CYCLPT Wl1LRE NOTED. EIXTURES: {II�DICATL TC?TAL NIIMBLit OP EACH II�LC3�h'} M[AIIMI,':vi rEE
$3�.Sfl.
BA"I"H 51NK,1LAV FLC)()R DIL�INS SHQ4VER WA`I'EK PII'1NG
_ [3ATEIT[IE3 (;AS P[P[NC; {'.V�ED CITY LIC) SW1MNfINCI P()(}L WATER Sl)F7TlER ($35}
_CLU1"HES �VASHER KiTCHEN 51'�!K 1tWATE-R GLt)S�T � BACKFLUW PREV (Sl i)
i DISIIWAS}iER _ LAUNDRY TR.4Y �13'ATGR HEATER t�3�} FC}R IRRIC;�TIC7N
V ��`ATF..R Tti1F..TER QTHER
TI {IS Iti AN ?,PPLICATI02v FC?R A PER:MT-NOT V.4L[D L"�iT1L FR(�CESSLD
I hereb�r appi}f for a pEtun63r7g perry�it an acknowledg at the informatian above is compPete and accw�ate; that the woi�; will be in
conformance �vith the ordinances and cudes the Cit f FridEey and w�th the ti4innesota Construction CadesT that l understand this is
r7ot a pertnit but anly an application for a peri `t ar is not to start without a permit on site; thak the work will be in accurdance
with the approved plan in the cas f ap or � c s rev�ew and appro al ot'pl i s.
SIt�'.VATl:RE OF APPLIC,AN'T � PRiNT NA'�4E �U-% �� f�� �`7J DA7E ! t l(r
AFPROti"AL ItiSPECTQRS S[GV�Tl'RE / A nATF .k a..�
City of Fridley
itding Inspections Department
] L;niversitv Avenue NE, Fridley,11�1N 55�32
7b3-572-3604
F�X: 763-5Q2-4977