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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT Date: .. ...... ZOwner: -.:.. ..... udder r .._ ... .. Address Address 14? C*i�O� ..... _.......... _._.......__ .._ _....... ....... ...... .. _.......!".._................................. _...... � ! gCATI N,, UI ING No. �.....,... Street . '' .. A!........ Part Lot Lot ...... ........... Block _............. Addition or Sub-Divisio --- --- Corner Lot ... - - ..._........_........ Inside Lot .. -- ......------------ .... Setback . ' - _........_ Sideyard .... , .. ,..._...-_............._.._.._. SewerElevation .._ ........................... ._....._...._............._........-•----............_........ Foundation Elevation _ ................................. _._.......... _.._........................ _............. ... DESCRIPTION OF BUILDING To Used as: t <"... Front t':._.. Depth ..f : _.. Height---. Sq. Ft._ "CU. Ft.0-kj. e-4� 40 14.4j_ .. Front 1-t ........ Depth ..qac , Height + Sq. Ft. jyJ..44 Cu. Ft... ' Type of Construction _. •ori .... Est. Coo ......., . .......... To be Completed .................................................. CAUTION THIS PERMIT DOES NOT AUTHORIZE VIOLAT- ION OF ANY PRI\./ATE LAND COVENANTS AND 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 upon violatia any of the provisions of said ordinances.��' _ . 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. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA 4 . P /a� Owners Name Builder Ad Address et 1 10 dress _7710— LOCATION %'0®LOCATION OF BUILDING ' No. / Street A a C , t of Lot Lot Block Addition or Sub.Div. 1 (_� Als Corner Lot Inside Lot ✓SeSet Back _ Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: 1 S- m Front Depth ••.,. f Cu. Ft. 1 A° c-vaa a Front , Debth 1 Sq. Ft. Cu. Ft. Type of Construction__r= _ Estimated Cost�,r To be 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 c ct. DATE L SIGNATURE _ (A Schedule of Fee costs can be found on the Lrse Side.) p,� Application for Rower Plantsand., Heating, Cooling. Ventilation. ,Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECIL WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ .each add. 80,000 BTU .. .................. 2.00 $ _ Replacement of Furnace .............................. .§.00 Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .......... I..... 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam .................... :. 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER -to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ........... x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM ALTERATIONS & REPAIRS TOTAL FEE $ 174 ROUGH FINAL Dept. of Bldgs . Phone SII. 4-7470 Location—C�— City of Fridley: 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 representations stated in this application ar% true and correct. Owner Kind of Wading � Used as v • To be completed about Estimated Cost, $ Old New. uilding Permit No. Permit No. 1,166 DESCRIPTION OF WORK HEATING or POWER PLANTS --Steam, Hot Wa Warm Air -No ,� �� Trade Name -4.,d p--�-� Size No- 4G ) /0 a Capacity Sq. Ft. E.D.R `rte BTU H.P. Total Connected Load Kind of Fue BURNER — Trade Name . Size No Capacity Sq. Ft. E.D.R BTU H.P. Y M WELTER HEATING C 4637 CHICAGO AVE. Signe MINNEAPOLIS 7,, MINNESOTA Bc ' i 4 Z 2M 7-59 Business Phone No (REMARKS—OVER) City of Fridley Application for Plumbing and Gas Pitting Permit Dept. of Bldgs. Phone "-7 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Oi NO. RATE x $1.50 TOJAL_ $ Future Fixture Opening ................ x 1.20 $` New Fixture Old Opening .............. ^ v� w $ w Z 3.25 * WATER HTR. x EIEC. $ New Ground Run Old Bldg . ............ x 3.25 $ 3V GAS FITTING FEES: o S0 a3 06 (3� Cio F N GAS .50 $ 3C1 x ® w oLL Base % 1st 2nd _ 3rd 4th • Future Connection Openings COe� I Sewer New Fixture, Old Openings Cesspool � PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures ...................... NO. RATE x $1.50 TOJAL_ $ Future Fixture Opening ................ x 1.20 $` New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $—% Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $--r/�61 City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do 411 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 applica ' are true d correct. .—� ; rArllav Minn_ t✓� 19—fid Owner Kind of Building Used as A To be completed about Estimated Cost, .New. Build ROUGH FINAL e2 2M 7-59 SUBJECT PERMI-T- OC City of Fridley 19347 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV. L PROTECTIVE INSPECTION SEC. r , ��� ' 1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 3/18/88 JOB ADDRESS 281 Rice Creek Boulevard N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. I SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Geor e Rvmer same 574-9581 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Robert Wilson-' 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING 7 CLASS OF WORK ❑ NEW ❑ ADDITION Ek ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof 9 CHANGEOFUSEFROM TO STIPULATIONS SEPARATE PERMITS ARE REQUIRED 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 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 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 $1,200 $•60 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 PERFORMANCE OF CONSTRUCTION. $20.50 PLAN CHECK FEE TOTALFEE $21.10 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI , PROPS LY V I TED THIS I YOUR P RMIT jl�,WHEN f At IF SIGNATURE OWNER IIF OWNER ILDERI IDATEI BLDG INSP OaTE NEW [ ] ADDN. [ ] ALTER. [ ] Construction Address Legal Description:_ Owner Name & Address: Contractor Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Corner Lot [ E City of Fridley R-1 AND R-2 Building Permit Application Effective 4/1/86 C &0 Tel . # � / Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. i Length Length Length Inside Lot [ ] Type of Construction: Approx. Completion Date: DESCRIPTION OF IMPROVEMENT Width Width Width Height Height Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Ft. Yd. Setback Side Yard Setback Estimated Cost: $ 1� b Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation J, - DATE: APPLICANT:� �; w Tel.-7 CITY USE ONLY Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $ 5,59 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] SUBJECT City of Fridley2 WI AT THE TOP OF THE TNS BUILDING PE1X11.0I 8 5 6 9 Lo jITY O DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 �'' 612-571-3450 ��%�J 0 / NUMBER 910415 REV DATE 11/12/98 PAGE OF APPROVED BY JOB ADDRESS 281 Rice Creek Blvd 1 LEGAL DESCR. LOT NO. 19 BLOCK 3 I TRACTOR ADDITION SEE ATTACHED Rice Creek Plaza North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Robert Wolleat 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Premium Roofing 6680 Lucia Ln NE Fridley - 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW O ADDITION O ALTERATION j REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof house and garage (21 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED 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 AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION ZONING SO. FT CU FT. 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 AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT VALUATION $1799 SURTAX $.90 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PERMIT FEE $56.75 SAC CHARGE j FiA SIC $1.80 PLAN CHECK FEE FEE Jk 4) -`jam Lic C ;0.45 SIGNATURE OF CON'RA TOR OR AUTHORIZEO AGENT IDATEI EN LI THIS IS O R P RMIT IN SP /D S-GNATURE OF OWNER,IF OWNERSUILDERI IOATEIBL w NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: Legal Description: 42L ElIKIC- Owner Name & Address: Acv,Tc"y°AGE=t7` Tel. # Contractor: �'! ✓��_ .� j MN LICENSE # a r�r 1 Z "t.�% Tel. # Address• �� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER:��- e- Construction Type: ��� Gi== /�°� -/�/�� Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: J �o� -� APPLICANT: a. ��.� — Tel. # CITY USE ONLY Permit Fee $ ~cP, Fee Schedule on Reverse Side Fire Surcharge $ f j ® .001 of Permit Valuation (1/10th%) State Surcharge $ 96 $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ 5-,60 $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: ',ITY OF F'RIDLEY INSPECTION DIViSiON�� 1431 University Ave NE Effective On January 1, 2000 =ridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, ���� z 763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES 4c. ") r55i /;1_ _ ru RAT&: SCHEDULE tesidentlal Rate TOTAL Fumace Shelf and Duct Work, Burner - Also Replacement Furnace $ 30.00 $ ... (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) Gas Range i0.00 $ Gas Dryer $ 10.00 $ 'Air Conditioning . All Sizes $ 25.40 All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or.Work $� :onmmercial/Industrial 1.25% of Value of Appliance or Work $ State Surcharge TOTAL FEE 1 11 • - '' i P,! 1INSPECTION FEE $47.00/Hr Air Conditioners can not be placed in a side yard without mitten permission from adjoining property owner. JOB A OWNER ��== BUILDING USED G-lt-.-2 C-C� ESTIMATED COST �` �J PERMIT N0,–`� DESCOF FURNACE –AND OR BURNER No_ of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Narne_Size No._ BTU—r!2�), CaLLD HP ^ EDR Fuel Total Connected Load .__. Burner Trade Name _. Size No. BTU _ HP — EDR 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 an rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. o DATE.. . Signe 'EL # – Approved By P46ugh-ln Date Final Date .2S 0� FILL OUT BACK SIDE FOR STACK VERIEK TION ON REPLACEMENT FURNACE T N 0 N ZO ' d -4101 COMMON MgMT. VENT CONNECTOR AND C0101JUSTION AIR i/EIZIFICATION When replacing an existing fumnce, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and ferestopped Where required. Yes (-)"'No ( } The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes (-Y-No ( } The undersigned also vermes that the replacement unit is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA -LAMA Category I Central Furnace: Venting Tables for fan assisted and natural draft appliances. Yes (LKNo ( ) The alit o combustion air is sized and installed to meet the cwrent codes and manufacturees speciflc ations. Yes (-No ( ) When required to install a new comibystion air. it will be sized and installed To meet the current codes and manufacturergs specifications. Yes (L"o ( ) When Installing a new venting Mtem, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does Include ACA LAMA Category 1 Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes (.Y'NO Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes (-I'No ( } Appliance TyM and Size/Cornrnon Vent and Vent Conn**tar Infarenation Appliance #1 Type 1U LQ_ BTU Input± ').l` n Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type ITU Input Fan Assisted or Nat Total Appliances ®, Total Btu Input Common Vent Type Vent Height Diameter inches Appliance 01 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height fi Length ft Diameter in Type Appliance #3 Vent Connector Sleight It Length It Diameter in Type AL° F-MTIONS: IDescribeD HEATING CO_ C�tf Signed By: Date: Z0/Z0 ' d S09869L 01 ATM I SA JO AM WO IJ BS : Zt 0002-ZZ-AON CIiYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 February 21, 2003 Mr. Craig Foxhoven 281 Rice Creek Blvd NE Fridley, MN 55432 Re: Final Inspection at 281 Rice Creek Blvd NE Contractor: Dave's Heating & Air Conditioning Dear Mr. Foxhoven: A mechanical permit was issued on January 15, 2002 to install a furnace at your address. According to the 1991 Uniform Mechanical Code a final inspection shall be conducted on the work authorized by this permit. As of this date the inspection has not been requested. The permit fee that was paid covers the inspection to make sure the work was completed according to the Codes. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will mark the permit "no inspection called for by homeowner after notification" and take no further action. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. DJ/mh .. _ .... _ .. _ _ ....,.. From: 763 425 7461 Page: 2/2 Date: 7/8/2010 10:22:44 AM Building PLUMBING Permit No.: I Inspections RESIDENTIAL APPLICATION Received By 763-572-3604 CITY OF FRIDLEY 0 7 763-502-4977 FAX EFFECTIVE 7-1-2010 DATE_ YOUR E MAIi ADDRESS r STCE ADDRESS S tom+ c �' C re ' �C`c THIS APPLICANT IS: Q OWNER AACONTRACTOR PROPERTY NAME:OVVNES 'C 'e-- CITY STATE Ip S�d-3. TENANT ADDRESS: ! _ h" PHONE: CONTRACTOR NAME:' _ ` trl LICENSE #__&0_ i r % b h1 EXP DATE / c> SUBMIT A COPY OFSTATE YOUR STATE LICENSE, BOND AND STATE BOND # EXP DATE C Y1l\ SS 3 CERTIFICATE OF ADDRS; 3 CITY �S�'G STATE ZIP INSURANCE PHONE PERMIT TYPE Pi,SINGLE FAMILY © TWO FAMILY ❑ TOWNHOUSE IM TYPE OF WORK: NEW PLACEMENT DETAIT,ED DESCRIPTION OF WORKe-f FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WFIERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $35.50. _ BATH SINKILAV _FLOOR DRAINS — — SHOWER WATER PIPING BATHTUB GAS PIPING (NEED CITY LCC) 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 Number of factures @ $10.00 x $10.00 = $ Number of fixtures @ $15.00 x $15.00 = $ Number of 5xtures @ $35.00 x $35.00 = $ State Surcharge $ 5.00 (AUNEWUM $40.00 Total = $ 40,00 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 for a pe 7nit d work is not to start without a permit on site; that the work will be in accordance with the approved plan in the of all v wh' r revrew and approval of plans. SIGNATURE OF APPLICANT CA.r 3 PRINT NAME ! �+�DATE 7 e 10 APPROVAL INSPECTORS SIGNA PLEASE NOTE: SEPARATE PERMTS ARE RE 1MD FOR BUILDING, ELECTRICAL AND MECHANICAL WORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, NN 55432 763-572-3604 FAX: 763-5024977 04 N '15