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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N° 4056 Date. ..... ..._7...... ....- ._" ... ...----..._-------_-----------------_--_-- Owner:---.._..................._..--------..-.-----------------------.....-.------.-----------------------------. Builder .. _ .._......_.............. .... --•---......-- _�l_.... Address Address LOCATION OF BUILDING No...Lot ... Q. J,T.../....... Street _ ... b- J.-.......... Part of Lot ............. ............. _ -- .............. Block .......... 5.1 ............................. .--- Addition or Sub-Divisio _ .' ....._. _. Corner Lot .................................... Inside Lot ............ ................. _........ Setback�� e.. ...... ............ Sideyard..ZO ................................. Sewer Elevation .......... ........................................ _............................ ........................ Foundation Elevation DESCRIPTION OF BUILDING To be Used as: ' �` �. v� v v� ��� _ .. ..... Front T„Y.:_0 . Deptha.�.r.. Height/7...-e�..... Sq. Ft. �/. ..r�! Cu. Ft. - - .................... _...................................... Front ....................... Depth Height ..................... Sq. Ft. ............... Cu. Ft. .................... _.. ...................... .. -_ Type of Construction....._................................................ ... Est. Cost �..... '.... �Wz:'.4 .-..'Ga_(f.. To be Completed .................... - ............. - ....... _........ In consideration of the issuance to me of a permit to consyett,building desc 'aboveI agree todo the proposed work in accordance with the description above send in comwith all provisions of ordinances of the city of Fridley. ,. u 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 within the city limits and this permit may be revoked at any time upon violation of an of the provisions of said ordinances. - / 1 Building Inspector NOTICE: This permit does not cover the construction, installation 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 I'M 4 7 s:1) Date: _ --.— Owner;�� `� ., ...8-... � � uilder _._.__._.___ :__._.._.:.........._._.�..��__ Address Js _ f y ; Address LOCAMN OFLDING t No.... _ .... Street _ _ E Lot Lot .....-----------....... Block __._._-._............_._ Addition or Sub-Divisio ...:. .. il. Corner Lot ----- ........ ..._.--....... Inside Lot .......... ... Setback _- ......__._... _: Sideyard ..--•- XF !.._...._.................................. SewerElevation_._.__------•--..._..__.._._.-----_-._....-......___.._.._...._......_ Foundation Elevation_.._.._........_...___....__......._.......................... _.......... ... DESCRIPTION OF BUILDING To bwUs as: ,q - Front .....rte. ._.. Depth Height'!'-.--. Sq. Ft. „/{ Cu. Ft. ...... ............ ............. - .._.............. ]int Depth ....._.. �. Ft....................... Cu. Ft. --_----_------ 7-r --- Type of Construction ....._ ..d:° Est Cost..------��'- ----.. To be Completed ............. __.._._....---.....---...... AjjH RIS VI®LAY. SAUCO�S AND ?HIS PERKY VENAN ,ON OF AN P ORATE FANO BUILOING RESTRICTIONS - 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 forth and in compliance with all provisions of ordinances of the city of Fridley. 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 within the city limits and this permit may be revoked at any time• on. of 'Aft of the provisions of said ordinances. Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these hems. •APPLICATION FOR BUILDING PERMIT•.: 1 CITY OF FRIDLEY,.MINNESOTA Owners Named va�/ts !�- �c 1 f� Builder (M M U .. Address Fi f PfV-&iiao2A DecUe- Address LOCATION OF BUILDING No. Street Part of Lot" Lot �� r ' Block _,?2 Addition or Sub.D�. -5P_0®e_U-fN� 2"—b���l Corner hot Inside Lot ✓ •Sef =Back. Side -Yard, SEWER. ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed builA#g location. DESCRIPTION.• OF BUILDING To be used as: '9 Front Z�®" Depth -25 �� a Height Sq. Ft. l 2 Cu. Ft. C., - , Front Depth Height. Sq. Ft. Cu. Ft. Type of Construction T�-IlTME-_- Estimated Cost To be completed The undersigned:.hereby makes application for a.permit for the work 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 representa- tions :stated in this application are .true and correct. DATE'S SIGNATURE (A Schedule of Fee costs can be found on the Reverse Side.) City of Fridley, Minn. N° 8037 BUILDING PERMIT Date: June 25.9 1965 Owner: T. L. Rocheford Builder Derauf Const. Co. Address Pandora Drive W. E. Address 30116 Stinson blvd. Mp18., 183 Mian. 971 LOCATION OF BUILDING No. street Pandora Drive ii. E. Part of Lot Lot - 17 _ Block 3, Addition or Sub.Division Brookview Terrace, 2nd Add. Corner Lot _ 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 s$150-0-0-0,00 To be Completed Storm damage repair 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 for" in ce with ail of ordiaaaces the city of Fridley. / / 1 In consideration of the payment of a fee of $10.00 , permit is hereby granted to Der&j Constr. Co. to construct the building or addition as described above. This permit is granted upon theEln, condition that the person to whom it is granted and his agents, employees and workmen, in all work. Allen Jessen Building hmpector NOTICE rob Pamh does dot effm 60 coestndion, haftnefloe hr WMhY, pbmddm an howb& "WW es amu. eo sun to see t6o euWng Mspector for apwa% pquft fey thou bmw City of Fridley, Minn.. N° 8251 BUILDING PERMIT Date: July 21, x965 Owner. Thomas L. Rocheford BuilderKnutson Bros. Address 971 Pandora Drive Address —4158 Upton Ave. No. LOCATION OF BUILDING No. 17 Street 3 Part of LotBrookview Terrace 2nd Lot _ Block Addition or Sub -Division Corner Lot Inside Lot Setback Sideyard Sewer Elevation To be Used as: Type of Construction Foundation Elevation DESCRIPTION OF BUILDING Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. frame Fast Cost __.. 15, 000_ To be Completed Sthrm damage. Rebuild 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 forth and in compliance with 21 provisions of ordinances of the city of Fridley. a „ . --, -L� 0.00 Knutson Brothers 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 andt 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 location, construction, alteration, maintenance, repair and moving of buildings within the city limits permit may be revoked at any time upon violation of any of the provisions of said ordinances. Allen G. Jensen NOTICE: Yid, pem b den net eewr the eondeoefloo, men for wiring, ph -bins, on heating, awer or wrier. Be am to ae the Building Inspedor for npan to permits for thea haea. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA NAME i .< �+ moi` .�BUILDER ii � X ADDRESS ADDRq�L&AC LOCATION OF BUILDING N0. STREET PART OF LOT LOT BLOCK ADDITION OR SUBDIVISION CORNER LOT INSIDE LOT 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. To be used as; DESCRIPTION OF BUILDING Front &? Depth Height Sq. Ft. 'Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost /,9000 To be completed '�%Icz—' 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 true and correct. DATE SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). Application for rower Pkmft and Hoof Cooling, ailed add Air q Sydem and Demos PARTIAL RATE SCHEDULE G vrrT WARM AM HATE TOTAL Spam ce ............. Z. 00 /. j_. .. $10 Replacement of Furnace ... CJ C. .. 6.00 ons—>Z ons --Up to M 6.00 $_-- Repairs & Alterations each add. $500.00 3.00 $ NZCIL WARM AIR Furnace Shell & Duct Work to 190,000 BTU ......... .. $10.00 6 emb add. 60,000 BTU .................... .. 3.00 6 Replacement of >:iUMM . - .. .. ...... ..... 6.00 $ Repairs & Alterations—up to $50.00 6.00 $ Repairs & Alterations each add. $500.00 .... .. ..... 3:00 $ STEAL[ or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. IDR Steam $10.00 $- Furnace Shell & Line—to 640 sq. ft. IDR Hot Water 10.00 $ Each add. 200 sq. ft. EDR Steam 3.00 4L--.—. Each add. 3M sq. ft. IDR Hot Water 3.00 $�— OIL BURNER—to 3 gaL per hour 6A0 = over 3 gal. per hour --See Fee Schedule GAS BURNER (up to 198,000 BTU) ... ... . 6.00 $ 15-, 00 over 198,000 BTU See Fm Sebeduk GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures . . .. . ..... x$ 100 ; y O Additional Fixtures .. .. ... x .76 $ Gas Range to 199,000 X$ 600 $ AIR C016DTt101111N0 FAN HEATING 9TS7301 See FM Schedule i/EnTILAT=a SYSTEM �— ALTERATIONS & REPAIRS TOTAL FEE $ ROUGH Imo, jf-�/- Z ! � I (SURCHARGE $—.50). �I City of Findley: The undersigned hereby makes application for a permit for the Work hereir 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 true and correct. J �, Fridley, Minn 7 (nQ e 2 Mt - lS * Kind of Building Used as&� _-7Z-7 -_ To be completed about _ I I ' L Z' 74- Estimated Cost, 3'- 1_ _ Ol New. Building Permit No. P.rmit No. �23 DESCREMON OF WORK BEATING or POWER Hot Water, Warm Air—No Trade Name Sine No Capaci Sq. Ft. ED A- BTU H.P. - Total Connected L—A Kind of Fust BURNER — Trade Nae Sine No Cal ty, Sq. Ft. E.D A- BTU NP (QMARM—ovERi CITY OF FRIDLEY Effective Date May 1, 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES _ RATE SCHEDULE 4ESIDEhTIAL RATE TOTAL Job Address 1-71 2elw . Furnace Shell and Duct Work, Department Buildings, Burner (Also replacement furnace) $ 20.00 $ of 6431 University Ave. N.E., Fridley, NN 55432 City of Fridley Gas Piping $ 10.00 $ Tel. #571-3450 (piping needed with new furnace) Gas Range $ 10.00 $ The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes Gas Dryer . $ 10.00 $ and rulings of the Department of Buildings, and hereby declares that all the ,�° Sizes j� hp, facts and representations stated in this application are true and correct. ' Air onii (�I $ 10.00 $ Fridley, Nina. '2 /®2 , 19 li All Others/Repairs and Alterations OWNER Z� li of Value of Appliance or Work $ KIND OF BUILDING COMMERCIAL/INDUSTRIAL USED AS It of Value of Appliance or Work $ TO BE COMPLETED ABOUT r ESTIMATED COST State Surcharge $ .50 TOTAL FEE $� OLD - NEW BUILDING PERMIT NO. PERMIT NO. ld V ►reinspection Fee ($15.00) $ DESCRIPTION OF FURNACE/BURNER Rough Insp. Date Final Insp. Date Approval for Permit % 4t/% o Q -S - It l MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00, PLUS $.50 STATE SURCHARGE *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. HEATING or POWER PLANTS, Steam, Rot Water, Warm Air- No. Trade Name'Z( j r/i/_,OiL Size No. Capacity Sq. Ft. EDR BTU HP Total Connected Load Kind of Fuel ana BURNER - Trade Name Size No. 61 Capacity Sq. Ft. EDR BTU HP Company � Signed By SE ® a � UUNU I 1UNIF41i UU. Tei. No. 8910 WENIlWORTN AVE. S0. U11MRAVULlb, 151 z 20 881-9000 Fill out back side for stack verification on replacement furnaces erg/ A CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; I. Has been carefully examined Yes ( No ( ) 2. Is free from rust or deterioration Yes No ( ) 3. Has no foreign objects lodged within Yes No ( ) 4. Is securely supported Yes No ( ) 5. Meets all current Code requirements for size and total BTU connected Yes ()® No ( ) 6. Has Total heating BTU's of / All other BTU's TOTAL % Remarks SEDGWICK MAIIIY{i d Alli WIVU111UNINU W. 8910 MTWORTH AVE. so Company Lem Signed By Date. 36 / . .I �i �F '.1' Y°l�` '�.: � •tls.�ll bYi 0 � 4��""'l�, ew d'4 �.. � • i� EDGWICK HEATING & AIR CONDITIONING CO. 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 • (612) 881-9000 ADDRESS 97/ pcind®C-ot Iiia OCCUPANT A ba al go cA c f on id SOLD BY S P (� ' W (f c i%l HEATING TEST RECORD CITY R%I dbe x OWNER /�-- -/-- INSTALLED BY e d G /.W It C `� MAKE MODEL SERIAL NO. %� Z� y INPUT 7 ZCzQn L i u THERMOSTAT/� 'ell LIMIT !rL J f VALVE 11., l 1 e LIMIT S T f' �`1 C C� LIMIT SETTING C) FAN SETTING- PILOT ETTING PILOT TYPE IGNITION MODEL PILOT TIMING PRESSURE /IW `�' PERCQ4T,COZ ! ( G INPUT CFH Z PERCENT 02 STACK TEMP. Z PERCENT CO NOh l FORM 235 (REV. 11189) VENT SIZE r TYPE 1OF LINER -��C� S 4 LINER SIZE JOB NO, FILTERS: SIZE M a ZJ NUMBER I WIRING TEST TAG LIGHTING INST. DATE TESTED P-2-91 COMPANY TESTING S e •I NAME OF TESTER FORM DISTRI ION: WHITE COPY - JOB FILE YELLOW COPY - CITY El IT NO. 29897 SUBJECT City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT f � -- NO. _____ COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. /- r^� r PROTECTIVE 1 . � CITY HALL FRIDLEY 55432 NUMEIER REV DATE PAGE OF APPROVED By L 612-571-3450 91O_F15 7/19/99 JOB ADDRESS 971 Pandora Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 17 3 Brookvi ew Terrace 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Anita Rocheford 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO QualityContracting11380 - 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 O ADDITION O ALTERATION Al REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof house and arae 25 S Tear -off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 $2185 $1.09 DOES NOT PRESUM TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHAR PROVISIONS OF Y OTHER ST E R LOCAL W REGULATING CON• STRUCTIO 0 HE PERF O Of ONS CTION $83.25 Fire $2.19 PLAN CHECK FEE TO7�LVELicen 5. $ SIGNATURE OF CONTRACTOR R AUTHORIZED AGENT DATE) ,9204tN O A E ISIS Y LIR P T F4V S,GNATURE OF OWNER,IF OWNER BUILDER) IDATEI BLD INS DATE IT NO. 29897 ., . NEW[ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: q 7 (r Rxelevct- Dv - Legal Description: Owner Name & Address: 14 M i 'f''OL IlD e-_ kV © V Tel. # Contract Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT TENSE # 7 0 3 S— Tel. # '-f 2 7- °7'x.3 � LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: ,v �( ks e ,C- o2S.5Qr Estimated Cost: $o2 0 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 1/APPLICANT: 1Z( -(t) c -,s— Tel. # �(2 7 -7 7-n CITY USE ONLY Permit Fee $ c E Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ 6, $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUIVIRFR OF FIXTI IRFA TC) RF INRTOI I GIl nM Geru Ci nno Effective On Jan 1, 2000 PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range** NO. RATE TOTAL JOB ADDRESS 541YIEAS 6610IE 12— Gas Dryer** - Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE The undersigned hereby makes application for a permit for the.work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the fuilding Division, and hereby declares that all the facts .and representations stated in this application are true and correct ROCHEFORD, ANITA 971 PANDORA DRIVE NORTHEAST�. 23 , 2000 FRIDLEY, MN 55432 Owner (763)571-3365 .. ._ Building Used As i'E6kDr-RP CR 00 _/ -3'Nn Estimated Cost PERMIT NO. PLUMBING COMPANY ®IZ��j%� L.U�'✓161A) �,� SIGNED BY TEL N0. Z" O Approved By Rough -In Date Final Date $ .50 ��//�� MINIMUM FEE FOR ANY PLUMBIN ]aAS PERMIT IS $2000 $JJ-� PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE mffi��ffim�la ,® FM FF. ROM ®. PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range** NO. RATE TOTAL JOB ADDRESS 541YIEAS 6610IE 12— Gas Dryer** - Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE The undersigned hereby makes application for a permit for the.work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the fuilding Division, and hereby declares that all the facts .and representations stated in this application are true and correct ROCHEFORD, ANITA 971 PANDORA DRIVE NORTHEAST�. 23 , 2000 FRIDLEY, MN 55432 Owner (763)571-3365 .. ._ Building Used As i'E6kDr-RP CR 00 _/ -3'Nn Estimated Cost PERMIT NO. PLUMBING COMPANY ®IZ��j%� L.U�'✓161A) �,� SIGNED BY TEL N0. Z" O Approved By Rough -In Date Final Date $ .50 ��//�� MINIMUM FEE FOR ANY PLUMBIN ]aAS PERMIT IS $2000 $JJ-� PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE