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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT Builder Address rLOCATI NOF BUILDING No. Street �.�� D-- Part of Lot /'%�- yyL3 N° 6455 Lot _ Block Addition or Sub -Division Corner Lot Inside Lot k—lf� Setback r __._ Sideyard P Sewer Elevation — Foundation Elevation DESCRIPTION OF BUILDING To Used as: Of Front Zl Depth 1. Height ZV— Sq. Ft. Ca. Ft. Front Depth Height — Sq. Ft. Cu. Ft. Type of Construction __ _ _ Est. -1%� __ To be Completed 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. In consideration of the payment of a fee of ig described above, Ito do compliance wit�a11 ons 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 Bart thereof, shall conform in all respects to the ordinances of Fridley, Minnesota reg d location, construction, alteration, maintenance, repair and moving of buildings within the dty limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances NOTICE: This permh doss not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be Sure to ase dw Building Inspector for Separate permits for these Ramm APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA ADDRESS LOCATION OF BUILDING No. C� `7 �� " /-�''�./.lil �f 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 build- ing location drawn on these Certificates. DESCRIPTION OF BUILDING To be used as: Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height, Sq. Ft. Cu. Ft. Type of Construction 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 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). Original PERMIT for Power ants and Heating. Cool- ing. Ventilation. Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of Heating Plants to be installed—altered—repaired Make d64a_,_� ,Size Oil fired_; Coal fired—,- Gas fired ; Gas Authorization Remarks Approved Final Inspection 19_ Inspector Permit N° 4576 Fee $ A2 - Office of the Inspector of Buildings City of Fridley City of Fridley, Minn. , 19 Owner ®A 22� . Location Kind of Building J How Occupied Work to be Commenced !�?- '/,19_�a To be Completed 5;,- / 5- ,19,E Estimated Cost, $ 575-• o, Old -New, Building Permit No. Permission is hereby granted to Lzi ,�a �l ' to instal-erect—use the material and devices described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named, and to the specifications set forth in the approved application for this permit on file in the office of the Inspector of Buildings. Inspector of Buildings .41�42 2M 11-67 d MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU each add. 50,000 BTU Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 STEAM OR -HOT WATER SYSTEM: Boiler & Lines up to 100,000 BTU each addn. 50,000 BTU Boiler only up to 100,000 BTU each addn. 50,000 BTU OIL BURNER- to 3 gal. per hour each add. 3 gal. per hour GAS BURNER- from 100,000 BTU to 199,999 BTU (over 199,999 BTU see Fee Schedule) The undersigned hereby makes application for a permit for the work herein $12.00 $ specified agreeing to do all work in strict accordance with the City Codes 4.00 $and rulings of the Department of Buildings, and hereby declares that all the 7.00 $,Oe— facts and representations stated in this application are true and correct. 7.00 $ 4.00 $ Fridley, Minn. —1-7 , 19Z OWNER ILS. $12.00 $ 4.00 CITY OF FRIDLEY 7.00 $ 6.00 $ $10.00 $ APPLICATION FOR POWER PLANTS AND HEATING,.COOLING, VENTILATION, REFRIGERATION AND .AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE �iCJL-tea GRAVITY WARM AIR: RATE TOTAL Job Address r� Furnace Shell & Duct Work $12.00 $ Replacement of Furnace Repairs & Alterations -up to $500.00 7.00 7.00 $ $ Department of Buildings Repairs & Alterations each add. $500.00 4.00 $ City of Fridley Tel. #571-3450 MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU each add. 50,000 BTU Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 STEAM OR -HOT WATER SYSTEM: Boiler & Lines up to 100,000 BTU each addn. 50,000 BTU Boiler only up to 100,000 BTU each addn. 50,000 BTU OIL BURNER- to 3 gal. per hour each add. 3 gal. per hour GAS BURNER- from 100,000 BTU to 199,999 BTU (over 199,999 BTU see Fee Schedule) The undersigned hereby makes application for a permit for the work herein $12.00 $ specified agreeing to do all work in strict accordance with the City Codes 4.00 $and rulings of the Department of Buildings, and hereby declares that all the 7.00 $,Oe— facts and representations stated in this application are true and correct. 7.00 $ 4.00 $ Fridley, Minn. —1-7 , 19Z OWNER ILS. $12.00 $ 4.00 $ 7.00 $ 6.00 $ $10.00 $ 10.00 $ $10.00 $� S GAS FITTING FEES: 1st 3 Fixtures x $ 3.00 $ Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00• $ AIR CONDITIONING $ FAN HEATING SYSTEb1S See Fee Schedule $ VENTILATING SYSTEMS $ ALTERATIONS f, REPAIRS � State Surcharge $ .50 TOTAL FEE $fie ROUGH INSP. Date FINAL INSP. J -3-W Date APPROVAL FOR PERMIT REINSPECTION FEE ($10.00) MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE KIND OF USED AS TO BE COMPLETED ABOUT AESTIMATED COST f � ✓ / ?A1 - NEW BUILDING PERMIT NO. PERMIT NO. �C,39e) DESCRIPTION OF FURNACE/BURNER (HEAT nor POWER PI'ANTS, Steam, Hot Water, No. % Trade Name Size No. -& /®� -� Capacity Sq. Ft. EDR _BTU /y -ed HP Total Connected load G` P- nd of Fuel - � BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Pany Signed fyn=.Tel. No.." 7—/4 (ik Z HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS Weatherstrips A. i -Ii L. Construction No. Guide Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof Floor i'es—No Yes—No 19_ G'1 I R,,.,.n Imoth -;0 CO Width? d Height II F1.1 Windows and Doors—Crackage and Area Width Height No. of Lineal It. No.. of pane of pane Ifghte of crack Width Height No. ofLineal ft. No. of Dane Dane Ifghte of crack Area eq. ft. `of ®®� Z /a 2 i Coef. Btu .� 6®f- Coef.1 Btu Infiltration % {J rP Coef. Btu Coef. Btu Infiltration £3 Exp. wall Net exp. wall a / Glass Glass Ceiling Exp. wall Exp. wall Floor /t/I2 07 Net exp. wall Net exp. wall Int. wall Int. wall Ceiling Ceiling Floor Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Length Width Height Windows and Doors--Crackage and Area Width Height No. of Lineal It. No.. of pane of pane Ifghte of crack Area W. ft. I+ 2,0 X-- /— Z /a 2 i Coef. Btu .� 6®f- Coef.1 Btu Infiltration Exp. wall {J / Coef. Btu Infiltration 5-6 £3 Exp. wall Net exp. wall a / Glass Int. wall Ceiling Exp. wall Floor /t/I2 07 Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.l Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of Dane of pane lights of crack ea. ft. Width Height No. of Lineal it. Area No. o[ ane of panePOO of crack sq. ft. Coef. Btu Infiltration Coef.1 Btu Infiltration Exp. wall Net exp. wall Glass AP 7 5-6 £3 Exp. wall Net exp. wall a / /00W Int. wall Ceiling Floor /t/I2 07 Cq® Total Btu. Reouired so. ft. E.D.R. or ea. ins. W.A. Leader area 1 C--- a► Insulation to Kind How Applied RMT I I math Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of Dane of pane lights of crack ea. ft. Coef. Btu Infiltration Glabb Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.l Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. itis. W.A. Leader area p1_I Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane llgl►te of crack eq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. WA. Leader area APPLICATION FOR HEATING REPLACEMENT ' CHIMNEY AND STACK VERIFICATION CITY OF MINNESOTA THIS FORM MUST ACCOMPANY STANDARD APPLICATION FOR HEATING PERMIT FORM. LOCATION OWNER Y DATE '% —/ �7 — % Q LESS r The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined 2. Is free from rust or deterioration 3. No foreign objects are lodged within 4. That it is securely supported 5. 6. That it meets all current Code requirements for size and total BTU connected Total Heating BTU All Other BTU TOTAL A7 1)'7 r REMARKS SIGNED _.L�erf�ee i by Address Telephone HEATING PERMIT # License SUBJECT P IT NO. City of Fridley 9 6501 AT THE TOP OF THE TWINS BUILDING P E R M I T r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 3/17/82 JOB ADDRESS 6449 Pierce Street N.E. 1 LEGAL LOT NO. 15 BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. A.S. #88 SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE 449 Pierce Street 3 CONTRAC Rr�effey MAIL ADDRESS ZIP PHONE LICENSE NO, Pilgrim Remodeling 10091 Pilgrim Way 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING. esidential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION CR REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Aluminum trim 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST, OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, aluminum VENTILATING OR AIR CONDITIONING. 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 19200.00 7. Lo WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES T PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PR SI NS OF ANY O STATE OR LOCAL LAW REGULATING CON- 20.50 STR CT NOR THE MANCE OF CONSTRUCTION. b PLAN CHECK FEE TOTAL FEE 1v • M__26=50 ' i • - N PROPEBIY VALID THIS IS YO R PE IT NATURE OF CONTRACTOR OR AUTHORIZED AGENT CD1 TEI SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI BLDG INSP QATE CITY OF FRIDLEY Effe, tive Aug. I., nal APPLICATIM FOR RESIDENTIAL BUILDING PEFU41TS (New, Alterations, Additions, or Repairs) OWNER: BUILDER: P/ ADDRESS: �� . G CA4/C-V'6..ADDRESS: % TEL NO: TEL NO: Construction Location STRICT NO: STREET: r�e R c� 411< � 7 LOQ.': � S BLOCK: ADDITION: 615 Co�ner 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. DESCRIPTI0N OF CONSTRUCTION Front: Depth: Height: Square.Feet: Cubic Feet: Front: Depth: Height: Square -Feet: Cubic Feet: Reps of Construction: �� '� Estimated Cost: Zb a Cbmpleted: Q 02 Alt. A Alt. D Proposed Driveway Width If New Opening Is Desired: SEE REVERS"E SIDE OF SHEET 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 rridley Ordinances and rulipgs of the Department of Buildings, and hereby declares that all the facts and representations stated in this application e ;true and c ct. DATEk/� � ? SIGNATURE: - Z?kd'dStipulations: R City of Fridley sueiEtr e28257 AT THE TOP OF THE TWINS BUILDING PERMIT i I • ' COMMUNITY DEVELOPMENT DIV. i M....._ , fr r . PROTECTIVE INSPECTION SEC. �//��! � � e , 1 NUMBER DATE PAGE OF APPROVED BY = CITY HALL FRIDLEY 55432 � t %.� 612-571-3450 910-F15 IREV 10/15/98 JOB ADDRESS 6449 Pierce Stre 1 LEGAL LOT NO.(Farce BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt.15 1300:1 A d ' SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Paul & Cheryl Hetland586-9567 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Northern Crest Inc. 8245 Polk St NE S792-9164 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 a REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (23 Sq) Tear-off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING. 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 ISTALLS 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 $1971 .98 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 E PERFORMANCE F CONSTRUCTION $62.25 Fire SC $1.97 [/ PLAN CHECK FEE TOTAL FE Licens 5.00 70 N ROPE DATE SIS YOUR PERMIT S-GNAT RE OF CON'RACTOR OR AUTHORIZED AGENT DATE, B G �NSo FiAtE S-GNATURE OF OWNER OF OWNER Bu4DERi iDATEi NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: 6449 Pierce St. NE Legal Description: Owner Name & Address: Paul & Cheryl Hetland Contractor: Northern Crest, Inc. Address: 8245 Polk St. NESpring Lake Park, MN 55432 Effective 1/1/98^^ �1 Tel. # 586-9567 MN LICENSE # 20098415 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Tel. #792-9364 LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Tear off and re -shingle house and garage $ 5.00 Construction Type: 23 square shingles Driveway Curb Cut Width Needed: DATE: Ft. + 6 Ft = Estimated Cost: $ 19171 17 1 (Fee Schedule on Back) Ft x $ = $ 10-15-98 APPLICANT: � Tel. # 792-9364 STIPULATIONS: CITY USE ONLY �°� Permit Fee $ �S Fee Schedule on Reverse Side Fire Surcharge $ /, 97 .001 of Permit Valuation (1/10th%) State Surcharge $ 20 $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ 5.00 $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 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 6449 PIERCE ST NE PIN : 133024310018 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT NO.: 2004-02031 DATE ISSUED: 11/05/2004 VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL FURNACE (WARM AIR, , 70,000 BTUS) # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 1 # GAS DRYERS # GAS RANGES 0 VALUE (FOR MINIMUM CALC) APPLICANT DAVES APPLIANCE HEATING & AIR INC 160137 AVE NE COLUMBIA HEIGHTS, MN 55421 (763)781-6901 5YO-011-ull HETLAND PAUL A & CHERYL A 6449 PIERCE ST NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regula ' con$ ction or the performance of construAtion. Bldg HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK GAS RANGE FEE GAS DRYER FEE AIR CONDITIONING FEE HEATING REPAIRS/ALTERATIONS STATE SURCHARGE, MECH FLAT I TOTAL PAID WITH CHECK # 35479 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 0 0 0.00 35.00 0.00 0.00 0.00 0.00 0.50 35.50 CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763=572-3604 FAX 763-571-1287 RATE SCHEDULE Residaential Fumace Shell and Duct Work, Bumer & also Replacement Fumace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *Air Conditioning -All Sizes All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater 8 5 8 5 1 Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEAVING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES — JOB ADDRESS � OH `�. t P/� d -- � - n Fee Tota Owner - - $35.00 $;� Building Used As $10.00 $ ESTIMATED COST PERMIT NOo�-� $10.00 $ , DESCRIPTION OF EU11 $10.00 $ # of Heating Units Circle One (Steam) (Hot Water' (Warm Aim Trade Name Size No. $25.00 $ BTU HP EDR Fuel Total Connected Load $ Bumer Trade Name Size No. BTU HP EDR Commercia.1/industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) $ Minimum Fee $35.00 for Commercial/IndustriaVinstitutional State Surcharge $ �y TOTAL FEE $f� REINSPECTION FEE $50.00/HOUR *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE 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 Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. Apprc Rough -in Date Final Date