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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT NO 3931 Date ....4...... ®6........... owner ....................................... Builder ��........... .. .. :............. r Address ...................................... Address ............................................. LOCATION OF BUILDING No. Street .. . :+n.. ...� .... Part of t ..... . . . . .... .. ... .. .. . . Lot ... ... Block ..... .. . ...... Addition or Sub-Divisi . Corner Lot /.@.......... Inside Lot . a ........... Setback ............. DESCRIPTI'ON OF BUILDING To be Used ... Front 7.� Depth ®�. f� . 4_Height :� \ Sq. Ft./o?(�.? Cu. �q s ....... .. Front Depth °: •. Height e.� — Sq. Ft. P .9 . Cu. Ft: �.�Type of Construction................... Est Cost.. �. .. ....... To be Completed :............... In consideration of the issuance to. me of a permit to construct the building desribed above, I agre . do the proposed work in accordance with the description above set fo and in compli a with all provisions f ordinances of the city of Fridley. In consideration of the payment of a fee of $0.? l.. , 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 anis 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 uy9n violation of any of the provisions of said ordinances. � 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. STATE OF MINNESOTA DEPARTMENT OF HUMAN SERVICES 444 LAFAYETTE ROAD F - ST. PAUL. MINNESOTA 55101 Date City of Fridley Zoning Authority 6431 University AVe. N.E. Street Address Fridley, MN 55432 City State Zip Code RE: ZONING NOTIFICATION OF APPLICATION FOR LICENSURE Subject: Name of Day dare Ho Applicant Street Add ss ni►�o City State Zip Code F iv /YtDBS-2722 (9-885) PZ -02722-02 Type of License: Family Day Care Group Family Day Care Licensed Capacity Phone No. 5-11— This -11 This is to inform you that we are in receipt of an application for licensure under Minnesota Rules, parts 9502.030 to 9502.0445 (formerly Rule 2), Family Day Care and Group Family Day Care Standards. Issuance of this license is subject to compliance with the provisions of Minnesota Statutes, Sections 245.781 to 245.812 and 252.28, subdivision 2, known as the Public Welfare Licensing Act and the rules of the Department of Human Services. You should note that under Minnesota Statutes, Section 245.812, Subvision 3, a licensed day care facility serving 12 or fewer persons shall be considered a permitted single family residential use of property for the purposes of zoning. Subdivision 4 of the same section indicates that a licensed day care facility serving from 13 through 16 persons shall be considered a permitted multi -family residential use of property for purposes of zoning. If we do not hear from you within will consider the above-mentioned your local zoning code. Sincerely, Licensing worker 0 1)() Street Address D 30 days after receipt of this letter, we day care home to be in compliance with COMMUNITY HEALTH & SOCIAL SERVICES DEPARTMENT COUNTY OF ANOKA COURTHOUSE, FOURTH FLOOR Name o Agency/Organization City State Zip Code AN EQUAL OPPORTUNITY EMPLOYER SUBJECT NO.20420 City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT i RECEIPT NO. ____--. COMMUNITY DEVELOPMENT DIV. Lu s7� / PROTECTIVE INSPECTION SEC. r �; CITY HALL FRIDLEY 55432 NUMBER REV. GATE PAGE Of APPROVED BY 612-571-3450 910-F15 JOB ADDRESS 180 Sylvan Lane N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED 5 2 Sylvan Hills Plat 3 SHEET DESCR. 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 572-8451 Timothy Glynn 180 Sylvan Lane N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 XQ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 22.' x 1516' Deck.Addition 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plan, WARNING Bijore digging call for all utility locations 454-0002 REQUIRE® BY LAIN TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $2r370 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $54.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $55,19. SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEIWHEN PROPERLY VALI TED THIS S YOUR PERMIT SIGNATURE OF OWNE IIFOWNER BUILDER IDA Ei BLDG INSP 'GATE NEW [ ] Effective 1/1/90 ADDN [ ] R-1 AND R-2 ALTER [ ] Building Permit Application Construction Address: a Legal Description: / `J , �j �bG% 4041 t�r'� P)a Owner Name & Address: A41) %� �'�, �l � Tel. # S%2; l Contractor: (Ol c) 1) �2 r Tel. # �C t�- Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DE.SQ2IPTION OF LIVIM AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length aaf Width (5'�Hgt/Ground 2L Sq. Ft. �Z�o 0THM: Corner Lot [ ] Inside Lot [SC] Ft. Yd Setback Side Yard Setbacks Type of Construction: i r (D Ica -4q P))'W- Estimated Cost: Approx. Completion Date: J111-1- Proposed 1111, Proposed Driveway Width If New Opening Is Desired: Ft. $ $ idth + 6' See Back Page. DATE: (p it APPLICANT:i /l r� C Tel.. Permit Fee $ '5-21 o o State Surcharge $ 1. SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side $.50/$1,000 Valuation, $600 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] The Chief Building official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: $1 to $500 $15 (Minimum Fee is $15 plus surcharge) $501 to $2,000 $15 for first $500 plus $2 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $45 for first $2,000 plus $9 for each additional $1,000 or fraction thereof, to and including $25,000 $25,001 to $50,000 $252 for first $25,000 plus $6.50 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $414.50 for first $50,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $100,000 $100,001 to $500,000 $639.50 for first $100,000 plus $3.50 for each additional $1,000 or fraction thereof, to and including $500,000 $500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional $1,000 or fraction thereof, to and including $1,000,000 $1,000,001 and up $3539.50 for the first $1,000,000 plus $2 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESC M (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. Permits for construction will be issued a minim= of 24 hours f - - ; the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. HARVEY A. CARTWRIGHT ANOKA COUNTY SURVEYS H6NNEPIN COUNTY SURVEYS MINNEAPOLIS SURVEYS 8410 PALM STREET N W SUNSET 4.7885 OWNER LAND SURVEYOR'S REGISTERED UNDER LAWS OF STATE OF MINNESOTA LICENSE "Y ORDINANCE OF CITY OF MINNEAPOLIS 326 PLYMOUT'W BUILDING FEDERAL 8-8721 INDUSTRIAL JUDICIALHENNEPIN AT SIXTH • MINNEAPOLIS 3. MINNESOTA BUSINESS — TOPOGRAPHICAL 6orurpor'!z Cmifttate CITY LOTS — PI-ATTING .1 OL�eI't tiu7,7ev eV 72.54 IL6 Orer hao Z,4 Al -Z - COMBINING THE RECORDS OF J. E. HILL. CIVIL ENGINEER ESTABLISHED 1896 C. F. SANDHOFF CIVIL' ENGINEER ESTABLISHED 1908 JAMES NELSON SURVEYOR ESTABLISHED 1922 METROPOLITAN LAND SURVEYORS, ESTABLISH@D 1941 Invoice 2c)-5'3 ,I.aL120 SCALE : s"=3®' -?—DEMOTES IRONS m ---DENOTES STAKES T_. 1� O . GP's s as � •:�. �- o. j14 E� 8rlck f RAE Fr ont f� l e7 I hereby, certi_'y th7t this is a true and correct reprosentrtion of survey of the boon -cries of: Lot , 31ock 12, -,*lv�n Hills Pl�.t 3 and of the loc-tion of _.11 buil ;inns, if-..n.v, thereon, %nd .:11 visib'.e encro_ch- pents, if m , f.ro.,-, or on s i,:a l_n,i, It l:,o sl:o.•;s ti:_: .1oc tLan of the st.'.ces s set for .. rropczc' In curve, -3.1 by ric this 21st ,Ii -y of SIGNED ,t?% WRIGHT AND OL90hY I 1n ! IL6 Orer hao Z,4 Al -Z - COMBINING THE RECORDS OF J. E. HILL. CIVIL ENGINEER ESTABLISHED 1896 C. F. SANDHOFF CIVIL' ENGINEER ESTABLISHED 1908 JAMES NELSON SURVEYOR ESTABLISHED 1922 METROPOLITAN LAND SURVEYORS, ESTABLISH@D 1941 Invoice 2c)-5'3 ,I.aL120 SCALE : s"=3®' -?—DEMOTES IRONS m ---DENOTES STAKES T_. 1� O . GP's s as � •:�. �- o. j14 E� 8rlck f RAE Fr ont f� l e7 I hereby, certi_'y th7t this is a true and correct reprosentrtion of survey of the boon -cries of: Lot , 31ock 12, -,*lv�n Hills Pl�.t 3 and of the loc-tion of _.11 buil ;inns, if-..n.v, thereon, %nd .:11 visib'.e encro_ch- pents, if m , f.ro.,-, or on s i,:a l_n,i, It l:,o sl:o.•;s ti:_: .1oc tLan of the st.'.ces s set for .. rropczc' In curve, -3.1 by ric this 21st ,Ii -y of SIGNED ,t?% WRIGHT AND OL90hY ob 'Q r �� C*x -10ZN Z - dQV J I A l t Ur PI I RMtJU I A UtrAK I Plt1Y I Ur HtAL I H ABANDONED WELL RECORD 1. LOCATION DF WELLI MINNESOTA UNIQUE WELL NO. 25790 (leave blank if not known) County Name Anoka Township kame� Township Number Range Number Section.No. Fraction 4. WELL DEPTH (completed) Date sealed N E h hof h Fridley 30N Sr 241a or 14 7.5' ft. 10-12-92 Numerical Street Address and City of Well Location or Distance from Road S. DRILLING METHOD (if known) Intersection 10 Cable tool 40 Reverse 3(Driven 10C1 Dug 180 Sylvan Lane NE . , Fridley, Mn. 5543 20 Hollow Rod 50 Air 80 Bored 110 30 Rotary 60 Jetted 90 Power Auger Show exact location of well ( , n sect ion grid with °X°) Sketch map of well location 6. OBSTRUCTIONS N Well obst t d 0 Y N W OMEN 7[( Air Conditioning 110 2. PROPERTY OWNER'S NAME Mailing Address if different than 8. CASINGS) ME 10 Black 40 Threaded 70 Glynn IKYiGaly. S[7 Welded EN= 30 Plastic 60 Stainless Steel 1 k 1 1n. to 7.51 ft. HARDNESS OF 3. FORMATION LOG COLOR FORMATION FROM TO Blom If not known, indicate formation log from new well or nearby well. in. to ft. Not known Gera :e House a es o Obstructions removed Q as 0 No If obstructions cannot he a a Z C Well 1 removed, contact MON E before sealing. 7,. USE 10 Domestic 40 Monitoring So Heat Loop I ) 2QQrrigation 50 Public 90 Industry 30 Test Well 60 Municipal 100 Commercial ,-- 1 Sst— n . Lane NE. 7[( Air Conditioning 110 2. PROPERTY OWNER'S NAME Mailing Address if different than 8. CASINGS) Timothy/Michell property address indicated above 10 Black 40 Threaded 70 Glynn IKYiGaly. S[7 Welded 93-102nd.Lane,N]". , Blaine, Mn. 55434 30 Plastic 60 Stainless Steel 1 k 1 1n. to 7.51 ft. HARDNESS OF 3. FORMATION LOG COLOR FORMATION FROM TO If not known, indicate formation log from new well or nearby well. in. to ft. Not known SCREEN 9. T „�v,,� 0 Screened weI rom ft, to ft. (If known) 0 Open Hole from a ft. to _ ft. 10. STATIC WATER LEVEL O t aval a e ft. [] below 0 above land surface Date Measured 11. WELLHEAD COMPLETION 10 PitlessAdapter Found Buried z0 Basement offset level with Basemen e��--.� 16. REMARKS, ELEVATION, Sl �°" FORATED. ETC. 30 Well Pit garage floor 12. GROUTINGINFORMATION Neat cement 2[] Bentonite 30 Previous owr. _—. ve sandpoin in garage'. ,1111' mior gnflll , We -11 grout motorl l Cc�MC-Pt from to 7 4J, Eu. Yo4mill Prepared for abandonment. Filled with neat cement from bottom to top. Casing 13. NEAREST SOURCES OF CONTAMINATION NONE level with garage floor. _ feet direction type Well disinfected before sealing? ($,Yes 14. PUMP 0 Removed MQMot Present g✓f r Type: 1[( Submersible 30 L.S. Turbine 50 Reciprocating • B r 20 Jet 40 Centrifugal 60 •r 15. EXISTING WELLS (Please sketch locations of abandoned and WA e active wells in remarks section or on back.) Other unused wells) an 0 Yes No su,a 10 w"r property? ® Abandoned: 0 Permanent 0 Temporary 0 Not sealed m �Q" Z Grasr WATER WELL CONTRACTORS CERTIFICATION 17. This well was sealed under m jurisdiction this y and report i 59 w is true to the best of my knowledge and belief. McAlpine Brothers, Inc. 862.70 AI "'� • –�2P•.6lcenSNORKin7SINdi.JJae License No. U O7 I F cm rs , Address �O5.5374 i?�iT' T CRS Signed .++Gate 10 / 12 Unkrrdwri Date Name of Driller FFICiAL ABANDONED WELL RECORD (May be used for Property Transfer) ZAPCiRTAHTs PILE WITH DMD iMA SUBJECT. City of Fridley 27671 AT THE TOP OF THE TWINS D I' I L D I N G PERMIT I r D �,J 1 � COMMUNITY DEVELOPMENT DIV. ______ 1 v PROTECTIVE INSPECTION SEC. r 1 NUMBER REV GATE PAGE OF APPROVED BY CITY HALL FRIDLEY 65432 "`j 612-571-3450 910-F15 9/10/98 JOB ADDRESS 180 S an Ln 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 5 2 Sylvan Hills Plat 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Greg Smith Rxm Sams 572-2307 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. New Haven Construction Co566-5229 20077990 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 8 DESCRIBE WORK Reroof house & garage (20SQ)Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply Nx with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 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 $1 714.00 $.86 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVI NS OF ANY OTHER ST E 1R L LAW REGULATING CON- $56.75 Fire SC $1.71 STR TI N OR THE ERFORM E O C STRUCTION. . PLAN CHECK FEE TOTAL F g -j- L e e SC $5. $64.32 SIGNATOR TRACT OR OR AUTHORIZED AGENT (DATEI EN OPER LIDATE D T SIS X48tM PER IT )NSP J 4aTE SIGNATURE OF OWNER OF OWNER BUILDER) IDATEIBLD Sep 09 98 06:22a Kerri 566-7163 p®4 Effective 1l1J98 AD1PN [ ] CITY ®F FRl®LEY ALTER[ 1 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConsttuctionAddress: ��� -L!' Legal Description: Description: Owner Name & Address: ¢ S ��m � Tel. Contractor: �,4"e-2 S MN LICENSE# 3oy ?7 y �' � c� & Address: LID a e.3 "d ,d%rl-(-A Tel..S W& r S s Attach tothis application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IS PROV KENT 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: f� . d �F - /` Estimated Cost: `pee Schedua a on Sack) Driveway Curb Cut Width Needed: Ft. + b Ft = Ft x $ — $ DATE: APPLICANT: Tel. # Perrnit Fee $ Fire Surcharge $ I State Surcharge $ - SAC Charge $ License Surcharge $ Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $--L--L'3,� STIPULATIONS: Fee Schedule on Reverse Side .001 of permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ From: 7634987274 Page: 1/1 Date: 7/22/2009 2:18:15 PM From: City of Fridley To: 7634987274 Page: X2 Date: 7/22/20891:43: D4 PM Engineering WATER AND SEWER Permit No.: 63 763-572-3551 - PERMIT APPLICATION Received By - -2 eL 763 -571-1287 fax CITY OF FRIDLEY Da d: 20 E; 6/9/09 r7EFIECTIV 1 1 APPLICTATION DATE / - X-4-0? YOUR E-MAYL ADD PLESS: tC + b. ! 1 C .S ; a Lek2 lea % in s-, TRIS APPLICANT IS: O OWNER I&ONTRACTOR JOB ADDRESS:I d!_0 , L -CL ArtC NEW CONSTRULTrION PERMIT1f (11 APPLICABLE): PROPERTY NAME: V TEa ANT Hc'-ar�- ADDRESS R(� sYi a. U1.f:ITVJ�- -- Ify STAT �'�' �/ PHONE: CONTRACTOR NAMLAO , sUBMITA COPY OF YOUR STATE ADDRESS 14) ?" C=e �,�1a -- ,, E�-r-----0 im .�s1i� s O r. CITY Gy1�y C ! STATr�r_ LIP LICENSE WITH PHONI _~% 9f�-7a-!2Q CELL PHONE: 6 / Ix o$,4 ^ ,Z S 6 APPLICATION STATE LIC # STATE BOND: 10CP DATE: 1. Na�rrative/written description: n ` 2. Please attach sketch showing curb Gne, utility line, building, etc. with distances. PERMITTYPE SEWER CONNECTION PERMIT $50 WATER CONNECTION PERMIT $58 WATER LINE REPAIR $48 SEWER L[NE RESPAIR $48 ADD STATE SURCHARGE $SO SAC CHARGE L $2000 OTHER CHARGES (IF APPLICABLE) PAY TO UTILITY BILLING NEW WATER METER COST — SEE UTI LITY BILLING SPECIAL ASSESSMENTS — SHE FINANCE WATER TAP — SEE ENGINEERING NOTE. WATER METER REPAIR, INSPOR SHUT-OFF /WEEKENDS & HOLIDAYS $125IHOUR-BILLED THIS IS AN APPLICATION FORA PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a water or sewer (now connection or repair) permit and 1 acknowledge that the information above is complete and accurate; that the work will be in conformanc with the ordinances and codes of the City of Fridley. I understand this is not a permit but only an applicationfor a I work is n to stmt without a permit. %� f►� �ry SIGNATURE OF APPLICANT PRINT NAME: ~Y DATE: f APPROVED BY:/ DATE:��� fO: ' f COPY G ILITY BILLING (only if new meter) PUBLIC WORKS ENGINEERING City of Fridley Engineering Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3551 FAX: 763-571-1287 D9