P - 45815From: 612 822 5408 Page: 2/2 Date: 6/22/2011 11:26:02 AM
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Building PL[T��YNG
Inspectians � + SII�ENTIAL A,PFLICI�TION
�63-s�2-3�oa �IT�.' OF FRIL'��EY
763-SD2-4977 FA� ..,.�.,..�...� _ _ ___ _
S11'E ADDtt�55 ,�,
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YOUR E•MAIL AD171tE55 �US��c. � �..� �,, ��� / � c.. ��,
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O OWLYtIt 1�{:flN'FRACTOR
'R4YEIt'I'X NAdiE: � � %
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TENANT AUDRF.SS: � L��� » n Jri.�z s� ,�� CITY� JI_ }�c�.. $TATF.�iTP .—��y
PHdNR� /���_��f � -��
S[:TBMi'C A COPY 0!�
Yf1UR STATE
LICL•NSQ BOND AND
CERT1FiGATE t3P
tNSURANCfi
PF.�� TYPE
STATE L2GCr�S� #_ b S5 2�!- P.�.� E7� DA7'� f�/3 J/ r 2..
9TATG 130ND # �G'�/.��I i� I7A'f� _
PHON� �/� �rf"�G - 3`�4 7 FAX ��� " f � �
�TNGLEFAMILY ❑TWOFAMQ.Y ❑'fOWNHOLISF.
TYPE OF WOitK: I❑ New
�iePt,ac.�n�r�r
DETAILF� I�E$CR[PTION OF WQRK _ �C.E � /'�.1� ,,/�/1,,. �.r , _ lr.... �r� -
� �'l%//
FEES ARE BAS�1 ON $1�+00 PL"•lt i�lX7'uRE, E7iCF'i'T VvFIEit� N01'l�ll. FI?fTIJRH$; (iNpICATE TOTt�lL NUMi3�it UY �AI:H 131L0\A+�. M1NlMUM FflE
l35.50.
—gATH S��AV „_�4�3R DRAINS SH0INER WATER k'IPINC
_ BA1'HTC1F3 GAS PIPINfs {NiGD Cl'Y'Y L1C} _$WjA�fiN(i PDOL i 4VA'CElt SUF CNER ($33)
_ca,�rFSwns��n =r�rre.ttErrsnvx wn�tci.ost,x —'r3ac�.t�wP�v.c�rst
_ OfSHWASHEIt _ f.A�7T10Iiy TRAY WAT�It IIEA"fCR (�35) T F'C)It IRRIGA!'tQPI
_ _ WATEitME'f�R �1'HER
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7'FT[S IS A1V AFPLSCA'fIUN FC3R A PF,T�I'T.NOT VAI.1D uN7'IL PRUCE55ED
I hcrcby apply fpr a plumbing pCrmit and I acknowledge lhat thc information above is eomplete and aecurate; that thc work will be in
confom�ancc with the ordinances and codcs of the Ciry of rridl�y and with the Minnesota Construction Caies; that i undeistand this is
not a permit but o��iy an. application £or a p it and work is not to start without a�exmit on si ; thaC il�e work wilI bc in accordance
with thc approved pian in tY1e 1• c i �equiCe3 rtivicw and appro pjans� r � f� � f,�
SIGA1nT[31t� OT AI�PI.ICANT i'RINT NqMii 4�. �ATF � ��
Arnnnvwr nucorrrnor.-rr„ri� � .
' Cify af FrY��'�►
Buiiding ��tspections DeparEment
6431 Univet�sity Avenue NE, �'ridley,lVil�T 55432
763-572 3604
FAX: 763-502-4977