P - 35208Building
Tnspections
763 -5 72-3 604
7f3-502-4977 FAX
PLUMBIN�
RESID�NTIAL �PPLICATI+DN
CIT� (�F FRII)LEY
�-rFt:rEr�F� i-1-zo� N
Permit No.: ��I I �
Received By:
Date Re�d:.,
DATE�--�� YC?t'R r-htAiL �DDAESS C.��1 P[ S6 /1 � GC t�SG h I!J✓!�1 �i /1 � CG %'y-J
SITE ALIDRESS �r �p �j �/ N l�% �� N�
THIS APPLfCANT IS� Q OW�?�:E3t $ICONTRACTOR
PROPER'f Y ' v an�E: s_J � ll/ �1/N/7 (i--
�WIVER/ ; ADDRE55 � �-Ir�l1 �- �/2 � CITY (`�J�..C� STA'
TENANT C��� � _.... �1./ �
� PHONE:, �_�O� � �,�. �I. _ . gl...� _. .�...._ ..w._.._ ,
coNTrtaCTOrt ; N,�E_ Larson Plumbing, Inc.
_ _
SUIiMI'1' A COPY OP ' STATE LICENSE N 58757 3341 PM Ex�r onrE 12/31/11
YOUR S7'AT"E
LiC}:NSE:. [30ND ANI) ; STATE Bc)ND � EXP DATE
cE:x�r•��ic,a•rF or• ,�,Da�ss 3095 162nd l.ane NW c,� Andover s�c.a�EMN z�r 55304
�NSURA�v�F ; pEfc�r�E 7fi3-�27.7680 � r-Ax 763-427-9448
PERMIT TYPE
TYPE OF WQRK�
� SINCiLE FAIN[Ll"
❑'i6W
❑ -['�VQ FAtiit�Y ❑ 7()1�'tv'HQCJSE
QI REPlACENfENT
DETAILED DESGRIPTION OF WORK Repiace Water Heater
FEES ARE BASED (1;�2 �l().00 PER FI7ZTLIRE. E?{CEPT WHERE NOTEC). F1XT[JRES° �1KDICATE TOTAL NLJMBEit OF EACH BE10W) M[NIMIJM FEE
$35.50.
BATH SINK,''LAV FLOOR DR�llNS SHDWER Y�iATER PIPIN(i
� BATFITEJB (iAS PEPINCi (NEED CITY LIC) SWIMMII�C PO(?L 1�ATER SOFTNER ($351
� CL.OTHES LVAS}lF..R KETCHEN S1NK VV"ATEA CLOSEf � BACICFLUW PREV. ($ I S)
� D[SHW.ASHL-R _ LAUNDRY TRAY �VvATER HEATER (S3i f FOR IRRIGATI(mi
_ WATER METER _ OTHER
TI[IS IS AN APPLICATION 1=0R A PEftMIT-NOT VAL[D I3NTIL PRUCLSSCD
I hereby appiy for a pEumbing permit and 1 acknowledge that the information above is complete and accw�ate; that the work will be in
conformance with the ordinanc d codes o e City Fridley and writh the Minnesota Construction Codes; that I understand this is
not a pemiit but only an appl' a' n for a p it d w k is not to start without a pennit on site; t6at the work will be in accordance
with the approved plan in t s f afl w ich ires review and appro t of plan .
SIGNATIJRE C)F APPLICANT PK�iN'T NAME �� � 1%I'n SU W [1ATE
APPROVALINSPEC'inRSSi _ 7'IiRE A/1 O� � DATC �7 _�!__ L
City of Fridley
Buitding Inspections Depai-tment
6431 [;niversiTy Avenue NE, Fridley, MN SSA32
763-572�360�
Fr1X: 7b3-502-4977
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