P - 481521 NML114911
Building
Inspections
7�3-572-3b04
763-502-�4977 F�iX
�'LUIY�IN�
�?.ES�DEI'�I'�'IAL APPI.I�ATItJI'�
CI'�Y tJF FRIDLE'Y
���, 12-&11 VpURE-MAILADDRESS
S1TE ADDRESS ,_6855 WASHINGTON ST NE FRIDLEY MN,55432
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'i'l�itS APPLICANT IS. t� {?Wi�TER X 'Ct1lV1'RkCTQti
O"WN��t/
�'EIVANT
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1'C3E3R &TAiE
LtCENSE, Bt7ND ANb
CEttT1�ICATE: OF
INSURAt3CE
PERMIT TYPE
TYFE Ui� WORKr
F���ti
Received By:
�
�p�; LORI STOLLE
_..... _
ADDRESS; 6855 WASHINGTON ST NE G1TY^FRIDLEY $Tq1E MN �p 55432
PiiONE:�,,,763-571-9562
NAME: LINNSTAR TRANSFER
__._.......
STA'PE LtCE1+iSE� 063901-PM EXP DAl'�
STA'CE BOTfD # �Ct' DA1E
ALtDRESS:,,,9995 W 69TH ST STE Ci'fy EDEN PRAIRIE
pi{pN� 800-856-6508 sT�� M� : 55344
FADC.
SlTTGLE FAivlILY O TWO PAMILY O'POWNHOUSE
�
X tREPLAC�MEMT
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DETAII,ED DESCRIP'T'[ON Cjp 'WpRi{ REPLACE DISHWASHER
533.5t)AFtE BASED ON 3 t0.00 P�R Pi�1i7CtE, EXCEP7"WNERE NOT'EI3'. FI7CfURES: (INDiCATE 1'U"i`Ai. NUMBER QF EAC[�iBELOWj. Mii�11M1jM �
BAT'H SINK(LAV �FLt�OR DRAINS SEJpWEIi � k?VA9'�R PFP1NCi
_ BATElTUB � GAS PIPING (NEEi) C1TY` l.iC) S WlMMING POOL ,_ VYATER SOPTFI�+R �535%
CLQTHE'� WASHER: r Kt'I'GiiEN SIN1G ^' WATER CLOSET _„_„8l��C1C�t:OW PR�V:'{S19)
1, I?►SHWAS}i�R ,_,_ LAUI�RX 71�AY WATF�L IiEATEli (S3S) kOA IRRf(iATION
` WA1'8R METER „�OTFIEit
_..._—
TIiIS iS AN APALiCA'ITON FOT2 A PERMIT-NOT VA�,ID UNTIL PROGE55ED
1 hereby apply for a plumbing per�nit a
er
coniarrnar►ce with the ordinances and c
nai a permit but nnly an epplication
with the approved plan in the case E'nll
SICIVA'I'URfi OF APPi.ICANT
� acknowledge that the information above is camplete snd �ecurate; ths�t the work wiil bo in
s o he Gity nf Fcidley arid with t6e p;tinnesota C'onstruction Godes: Ehat I understand this is
it and wortc is not start v�ia�i c�t a permit an site; that the work will be .in ac anc.e
whi i d ap�of plan�. _� i� �
.�. / � NT�NdKXG` ARI FC (�ARRFI f`IlC 12-61� �
City of Fr�dley
Br�'tiding Tnspections Department
6�31 Una'versity A�enue NE, FricCle�!, Mhi �5432
763-572-3504
FAX: 7G3-502-4977
PLEASE SEND PERMIT
TO HOME O�JVNER! !
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