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PRE 2010 DOCSBUILDING PERMIT Village of Fridley, Minn. N° 2416 Date 41-.:Z.3..—..�.`l....................... Owner...14'�""...�.�.� ,!it.���1f�lY�rs► milder .......................................... . c7l; 0-1 Address i`s ..1 'r' 114'10........ Address ......................................... LOCATION OF BUILDING No.... .`'r.�....... Street. •a`.a" gyc1 P� art of Lot . t.'............ ... . !fir"-sf''c'�' may" Lot ......7........ Block ................ Addition or Sub -Division /' ... 4090........ . Corner Lot .. v...... Inside Lot ............ Setback + '' .. Sideyard *,T.C. 4r -*0 ............... DESCRIPTION OF BUILDING To be Used as: Front . ?!1! . Depth AI AP . . H p,;'" . Sq. Ft. P.. ,/'�!': Cu. Ft. .................... Front ........ Depth ...,...... Height ......... Sq. Ft......... Cu. Ft......... Type of Construction 0^8 .0 Est. Cost � j►' y ; t ............ To be Completed In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set fo m compliance with all provisions of ordinances of the village of Fridley. . 1 "4► !'A f aeration of the payment of a fee of $.d.... , pe is hereby granted to .�................. . .. ,j......... to construct the building or additi as described above.ermit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Building Inspector NOTICE: This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for'these Items. City of Fridley, Minn. BUILDING PERMIT N® 3851 Date: ............ Owner... ..... ......... .. ..4 � . ... Builder .... .. ........ ..... Address ................................... Address ............................................. LOCATION OF BUILDING No. ..:7....-3 Street .....�^ ... ............ Part /of'I t ................... .. Lot ...... .... Block .................. on or Sub -Division .CAR"l�G7 CK�f . Corner Lot ............ InsideLot ............ Setback ............ Sideyard ...................... DESCRIPTION OF BUILDING To Used as:t a 19 f rr �/ ... vias 01�_� � �S ...... Front ;20-;'F Depth P�. Height f.Q :� sq. Ft. .7 � G , Ft. l.. . .................... Front ........Depth ........ Height Sq. Ft. ........ Cu. Ft. ........ Type of Construction ................• .Fast Cost... OR .......... To be Completed ................... In consideration of the issuance to me of a permit to construct the building desribed above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. X .................................................... In consideration of the payment of a fee of permit is hereby granted to ................... ......................... to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it Is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. _ .. a Building Inspector NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owners Xam Builder Addressi Address . LOCATION OF'BUILDING. No.. ,: Street r!�? Part of Lot Lot, Block. Addition or Sub: Div. ' Corner Lot ✓ Inside Lot ..Set Back Applicant attach to this form Certificate of Survey of Lest and proposed building location. DESCRIPTION OF-BUILDING To be used as Front �`� Depth Height Sq. Ft- ® Cu. Ft. Front Depth weight Sq. Ft., Cu. F`t -- - Type of Construction —/��� Estimated Cost To be, completed l r 6 The undersigned hereby makes application for a permit for the wort herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby ' declares that all the facts and representations stated in this application are rue and correct. e Date Signature (Aedule of Fee Costs can'be found on the everse.Side) %� 7 3 City of Fridley, Minn.. N° 7966 BUR DING PERMIT Date: June 22, 1965 Owner: Mr. & Mrs. Schinke Builder Ron -Jon Builders, Inc. Address 703 Mississippi St. N. E. Address 8516 Xenia Axne, So. LOCATION OF BUILDING No. 703 Street Miss. S t . N' E. Part of Lot Lot 7 Block — _ Addition or Sub.Division Clover Leaf Add. Corner Lot _x Inside Lot Setback Sideyard Sewer Elevation — Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Front Depth Height Sq. Ft. Cu. Ft Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Est. Cost $5500.00 To be Completed Storm Damage Repair In consideration of the issuance to me of a permit to c the proposed work in accordance with the description above ordinances of the city of Fridley. I above I agree to do with a'l1 provisions of In consideration of the payment of a fee of1$ 0.00 Z —psr�dtis hereby granted to Ron -Jon Builders to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any gait thereof, shall conform in all respects to the ordinances of Fridley, Minnesota location, construction, alteration, maintenance, repair and moving of buildings within the city limits ant permit may be revoked at any time upon violation of any of the provisions of said Allen Jensen Building r NOTICE fhb peredt don wo emu the eoedruatieu, halaQafta fw wMh& pkmdd8. gas 6eatlag, nWW u crater. Be sun to no the Budding r for aepm to paamft /u tin:• Items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER ' S NAI+B;� K' 2� .:� BUILDER ADDRESS� �� ADDRESS efSo LOCATION OF BUILDING No. �y — Street �Part of Lot LO . BLOCR ADDITION OR SUBDIVISION Corner Lot_.Y_Inside L Setback Side -Yard SEWER -ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates-. DESCRI SON OF BUILDING To be used as: Type of Conotruetion To be completed Front Dept Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Estimated Cost ,�e9 The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this -application, are t e yndcoct. DATE) SIGNATURE (Schedule of- Fte ;Costs can be found on the everSide) . P SUBJECT P City of Fridley 16635 AT THE TOP OF THE TWINS BUILDING PERMIT _ • _____ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. y/-y y I CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/14/82 JOB ADDRESS 703 Mississippi Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 1 Clover Leaf Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Eleanor Schenke 703 Mississippi Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Jack Johnson Builder 1796 Silver Lake Road 636-7236 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Reroof Dwelling 9 CHANGE OF USE FROM TO SnPULATIONS,, Roof can be the 2nd but not the 3rd roof. Install ridged galvanized valleys. a TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Asphalt THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SP&rIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,100 $.55 DOES , PRIES TO GIVE AUT ITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PRO V 10 S OF Y OT R STA R LOCAL LAW REGULATING CON- ST CTI 0 E PE F MA OF CONSTRUCTION. 19.00 PLAN CHECK FEE TOTALFEE $19.55 NATURE O ACTOR OR AUTHORIZED AGENT (DATE) %WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT BLDG NSP U T SIGNATURE OF OWNER OF OWNER BUILDERI IDATE) CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATIM FOR RESIDENTIAL BUILDING PERMITS (New, Alterations, Additions, or Repairs) 0WNER: ADDRESS: TEL NO: QUI LDE R : awl C. �� �CJ �I, it raa ADDRESS: / 2 76- TEL 140: ul —? 4 " 7� � Construction Location STRICT NO: STREET: (9- /_J` x e ,j)� / 'A �a 6 V IAT: BLOCK: ADDITION: C / 0 Q'74 4. �� Corner Lot: Inside Lot: Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. e Q- ._ C. Front: DESCRIPTION OF CONSTRUCTION Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square -Feet.- Cubic Feet: Type of Construction: -zl&b A'a T Estimated Cost: To Be Cbripleted: e4? a -'L 4c Eel Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET . Tile undersigned hereby makes application for a permit for the tork' herein specified, agreeing to do ,all wort: in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, fim4 hereby de ares hat all the facts and representations stated in this applica on are trje/ar3,8 c - ect. M D.1TE: 6 ^/ V ` SIGNATURE: Stipulations: �L �®,c Imo. N SUBJECT P O. City of Fridley 30 1 4 6 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. f PROTECTIVE INSPECTION SEC. i CITY HALL FRIOLEY 55192 NUMBER REV DATE/31/99 PAGE OF APPROVED 8Y -_-•�"'1 •� 612-571-3450 910-F15 �c7C X JOB ADDRESS 703 MiSSiSSiDDi Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 1 Clover Leaf AdditionSHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dan Johnson 502-9947 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW O ADDITION O ALTERATION x12 REPAIR ❑ MOVE O REMOVE 9 DESCRIBE WORK Reroof house and garage 23 S Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 2010 $1.01 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFOR NCE OF CONSTRUCTION $83.25e sr A2.01 PLAN CHECK FE T AL FEE SIGNATURE OF CON • AA pR OR AUTHOAREO AGENT IDATEI HEN P , A ED THIS IS R 7 SIGNATURE OF OWNEA..F OWNER BUILDER. IDATEI '5 BL INSP FIA It N NEW [ j Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY / ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: JO 3 M SS La4q,, ," SJ-. 1 Legal Description: Cy,.e,. Le�� a�_��: d Owner Name & Address: Dah 34s'oh (GArks"; Sah.p eS 640 Tel. # S®� - 7941/7 Contractor: „ S { MN LICENSE # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EM PROVEMENT Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: IZ-,k r o d� irn n t-C.e -A- c r, .-- A & _ Cr L c Construction Type:_ I'S1-kvr4 S�, ,.�Q� e S Estimated Cost Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: 19- �`� APPLICANT: is am Tel. # Spy g `zc�z Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1050 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] Building NDIrjAN $ 37.185 19 1001 BUILDING $ Permit No, $ Surcharge $ If •79 License Surcharge $ '6.00 Inspections $ RESIDENTIAL APPLICATION $ Received By: 763,-572-3604 Park Fee CITY OF FRIDLEY • Sewer Main Charge mate Recd: � DATE ' -01 YOUR E-MAIL ADD S 1 m n n es�+a-- r to s e o C U m SITE ADDRESS 70 ► Y L 3z THIS APPLICANT IS: ❑ OW1kR CONTRACTOR PROPERTY OWNER/ NAME: OK4 SM TENANT ADDRESS: . CITY STATE ZIP PHONE: 203 -OA. 59ii7 CONTRACTOR NAME SUBMIT A COPY OF STATE LICENSE # A 173 EXP DATE 351.10 MAr &!A -C -YMTF–w 55313 YOUR STATE LICENSE ADDRESS: 5SSB CITY STATE ZiP WITH APPLICATION PHONE 9SZ • 935 9 (ole 9 FAX `?5Z 92 gs�y PROPERTY TYPE ❑ SINGLE FAMILYINEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE M ADDITION ❑ GARAGE/SHEDWS 0 BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION 3KIAINTENANCEMEPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S . Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. 2. Existing Floor Plan Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Ahuninum ❑ Trim 1. Site Plan/Survey showing the existing structures Other ❑ Fascia and proposed project WINDOWS``,, 2. 3. Two sets of construction plans Energy Calculations IN EXISTING OPENINGS $Yes [No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF Jn7tJU/ h D RAG OPENING CHANGES & Q bS TYPE OF WINDOW TO BE INSTALLED ER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $13, sfi9.O0 OCCUPANCY TYPE Permit Fee $ 37.185 Plan Review $ Fire Surcharge $ Surcharge $ If •79 License Surcharge $ '6.00 SAC Charge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ • Sewer Main Charge $ Total Due $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1550 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftxS21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attac THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a p rmit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work which r iresrevie d a p v of plans. _ KP ,n, SIGNATURE OF APPLICANT NAME -..) Qk DATE � �Y Building PLUMBING Permit No.:��"� � Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Recd: 763-502-4977 FAX EFFECTIVE 1-1-08 DATE i-I YOUR MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: -�KWNER OCONTRACTOR PROPERTY NAME; (a OWNER/ ADDRESS:���S1�,I� CITY STATON ZIPSs�3� TENANT PHONE: 7 CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND STATE BOND # EXP DATE CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE . PHONE FAX PERMIT TYPE QINGLE FAMILY 0 TWO FAMILY ❑ TOWNHOUSE 0 NEW REPLACEMENT TYPE OF WORK: DETAILED DESCRIPTION OF WORK �- �nl ��c�- rY, �. > n u s, �vs"( PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x .05 = plus .50 surcharge OR FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $1 0.00 PER FIXTURE, EXCEPT WHERE NOTED. FI RES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $15.50. SINKILAV DRAINS _ SHOWER WATER PIPING —BATH _FLOOR GAS PIPING (NEED CITY LIC) _ SWIMMING POOL _WATER SOFTNER ($35) —BATHTUB _ —CLOTHES WASHER _ KITCHEN SINK _ WATER CLOSET _ BACKFLOW PREV. ($15) DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION _ WATER METER —OTHER POW I171111 511MI Mi i IN i OWN k Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ , Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ OR Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 (MINIMUM $15.50 (MINIMUM $15.50) Total = $ THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application fora p rmit and work is not to start without a permit on site; that the work will be in accordance fort with the approv Ian in case of a/ll o hick requires review and approval of plans. )� SIGNATURE OF APPLIC T P'� PRMTNAME Nn �`J` p �'�� DATE APPROVED BYue DATEI UK L a City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building PLUMBING Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: 763-502-4977 FAX EFFECTIVE 1-1-2010 DATE ' I C:;, YOUR E-MAIL ADDRESS wn C�or1 S B • �� SITE ADDRESS 7a3 M S S; S S1, F y? THIS APPLICANT IS: MWNER OCONTRACTOR PROPERTY NAME: D G ' nsz' ADDRESS: -703 Pk i SS, S R, N' E ri STATENZIPS_ OWNER/ TENANT —,CITY PHONE: 7 63 -So7 CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND STATE BOND # EXP DATE CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PERMIT TYPE INGLE FAMILY 0 TWO FAMILY ❑ TOWNHOUSE 0 NEW - &REPLACEMENT TYPE OF WORK: DETAILED DESCRIPTION OF WORK h, hw-et-r �" v rJ\J-k FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $35.50. BATH SINK/LAV FLOOR DRAINS _ SHOWER —t,, WATER PIPING _ BATHTUB GAS PIPING (NEED CITY LIC) _ SWIMMING POOL _ WATER SOFTNER ($35) _ _ CLOTHES WASHER KITCHEN SINK —WATER CLOSET _ BACKFLOW PREY. ($15) _ _ DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION _ _ WATER METER OTHER *.s40., k ;t i.� i f }'k p Y ?u�-e"rl wn IN i _. THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only anapplication for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan i' the case of all which requires review and approval of planes. 1 u SIGNATURE OF APPLICC PRINT NAME D�11 J6T�YlSorl DATE 1 f City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977