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2009-01435 jieering WATER AND SEWER Permit No.' ► -o i o 572-3551 PERMIT APPLICATION&" ` Received By: C ft cro CITY OF FRIDLEY 763-571-1287 fax D fgrJ'sEp 2 2 2i t r� �1 Q c� EFFECTIVE 6/9/09 APPLICTATION DATE: �,r/ ,+e�e q YOUR E-MAIL ADDRESS: D RfI K I S f Q 4.L • c ti 4,0 THIS APPLICANT IS: 0 OWNER CTCONTRACTOR JOB ADDRESS: X94/b 5 F/At i - (3 4 ? NEW CONSTRUCTION PERMIT#(IF APPLICABLE): PROPERTY NAME: TENANT ADDRESS: f-5/4(C') I,/mss.?.sem 134••J CITY /G"!r�Lu./ STATE ZIP PHONE: CONTRACTOR NAME: D0.40 PteKKg,-1 �...Q•�.-i ice £.-t • SUBMIT A COPY OF q YOUR STATE ADDRESS: !006.a. (4(s•✓!,r w CITY _ STATE/40' ZIP.5770'5 LICENSE WITH PHONE 763 '(411-6/abet CELL PHONE: -? - y APPLICATION STATE LIC# /9 G/y LI.. Pal STATE BOND: C! $ I)VS y EXP DATE: 1. Narrative/written e/wr�itt'en descri ion: /fid.' 2. Please attach sketch showing curb line,utility line,building,etc.with distances. PERMIT TYPE ❑ SEWER CONNECTION PERMIT $50 El WATER CONNECTION PERMIT $50 ❑ WATER LINE REPAIR $40 ElSEWER LINE REPAIR $40 t 1 O ❑ ADD STATE SURCHARGE $.50 .GJ ❑ SAC CHARGE @$2000= LIQ c OTHER CHARGES(IF APPLICABLE)PAY TO UTILITY BILLING NEW WATER METER COST—SEE UTILITY BILLING SPECIAL ASSESSMENTS—SEE FINANCE WATER TAP—SEE ENGINEERING NOTE: WATER METER REPAIR,INSP OR SHUT-OFF/WEEKENDS&HOLIDAYS $125/HOUR-BILLED THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a water or sewer (new connection or repair) 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. I understand this is not a permit but only an application for a permi _.,,�. work is t to start without a permit. SIGNATURE OF APPLICANT �' �,s%ZPRINT NAME: ,{24P4F.-Pel*R°/. s DATE: ,2S O 7 APPROVED BY: _ ...f DATE: _ COPY GI I T ❑ UTI TY BILLING(only if new meter) ❑ PUBLIC WORKS ❑ ENGINEE' NG City of Fridley Engineering Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3551 FAX: 763-571-1287 '0 • dave fr i contracting 7060 143rd Ave. NW, Ste. 100 • Ramsey, MN 55303-6014• (763) 427-0109• Fax (763) 427-3806 ATTENTION ALL RESIDENTS Ref: Stinson Blvd NW Sub: Street Closed Due to sewer repair Stinson Blvd NW will be closed Thursday September 24th From 8:00am to 7:00pm At the address of 5940 Stinson Blvd NW the street will be closed to thru traffic. Detour: Gardena Ave To Benjamin Street To 61st Ave 30622 Forest Blvd • P.O. Box 430 Stacy, MN 55079 Phone: (651) 462-2130 ENTERPRISESRoyal MFax: (651) 462-6990 Royal Concrete Pipe, Inc. • Royal Environmental Systems, Inc. • Royal Erosion Control Systems, L.L.C. 'IP Dave Perkins Contracting, Inc 7060-143rd'Ave NW Ste 100 .„5-'74/...5 -' .)r - , 1 Ramsey, MN 55303-6014 20X 33 - or G (3i c i roC 1 /1 --- �r Zerno v c 51 y v 1 It ( o ` G el-6a a o s,,.1 w Ye F-c) / 4,0_ c 10-4)013( vi 4/ Visit our website at: www.rovalenterprises.net l ► ', r . •. . I . 11 I t I I I f . 1 . k , i 1 I t i Li i i Ci L I L , L . L . L . c , • , • t . . • • k • • ,, y _.� r.�.ux s'"o o.♦... __..,,vG \a a' -. - A C y „s.-... 3f't rill - C v �fHAM:HtH G ..C' • --• • n o ap' a 4 „xgLy"� o tit > \cam. g ,.� m� COMMERCE o Z.. k, rn• \ y� RD m -O N0 6C\ i_1 2_t -ST x NE TAR, 1 a i I� .7' `��s m �o wYVFRS�DR COMMERCE GRE \W SERVICE DR o m ." F , o0 • m — '1 S - D Ns y . 4TH sr .03k10 33i. -. o NIVERSIT � � AVE NE z m m ` -1:1� xc/3 Y►wrpT. 111114 171 o o D ' STN .>,: •-� � _ D s x ' ® a�� NE AM �. a D TH e(Vp ► mo-< S 5TH RST m 5 5TH r� NE < o i c , I < ;' >16TNm" m STA NE R, ,-'`- m 77-,<,, _ < w m g TE/IgP ,� = N-., • H m . 5�i p ne D D TE-R ,w646;• W cn ° IA? 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