PRE 2010 DOCSCity of Fridley, Minn.f
6431 University Ave. N.E., Minneapolis, Minn. 55432
BUILDING PERMIT
ate: _ May 22, 1972
OWM: T.P.-if Npnrikcan Builder SamA _
Address 495 Mississippi Street N.E. Address Same
LOCATION OF BUILDING
No. - 6Q -,i6 Street - 21i Street N.E. _.... Part of Lot
Lot 5 Block 7 Addition or Sub -Division Ilyde Park Addition
Corner Lot Inside Lot – X- Setback Sideyard —
"ekr Elevation 84L74 9iUd4"t4&14a i&Y 844,74,Wpxox . )
Wye Top of Footing
DESCRIPTION OF BUILDING
To be Used as:
Dwelling Front 42 Depth 58' Height 20' Sq. Ft.1125 Cu. Ft.22, 550
Garage Front - 94' Depth _201_ Height —10.1 _.. Sq. Ft. _.. 48D 1_ Cu. Ft. _ 48O.Q
Type of Construction - Frame East. Cost ..$21,'166 To be Completed Eegt-1, 1972_.
Stipulations: Provide a hard surface drive. Provide a verifying survey before
capping.
WATER LOCATION: 10' S. of Sewer Service SEWER LOCATION: 111' N. of Manhole.
(Must Be Tapped)
In consideration of the issuance to me of a permit to construct,4be building des d above, gree t9 do
the proposed work in accordance with the description above set a1 in m ce with rovisions of
Ordinances of the city of Fridley. U // n _ / e
10.68 Sta
In consideration of the payment of a fee of $— 551 00 permit is hereby granted to--Ie?tf Henricksen
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
piidley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildin>�
V.1tbin the city limits and this permit may be revoked at any time upon violation of any of the provisions oihanoes
f said
wilding Inspector
CLARENCE BELISLE
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.
ar
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAM: ; i ' Ae- h r^ o ,2
J. !`c YTBUILDER : y:, P_ ; e d e^ .,
ADDRESS • ADDRESS: �
7`
NO:. 3 4p STREET: -?/.,g S 7'J E–
LOT : —BLOCK:— ADDITION: Y 0�' aa r-
CORNER LOT: INSIDE LOT: v SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
Lf e- ' oj Front: '!9'� Depth: 5- Height:
Square Feet: Cubic Feet:
v,a c Front: Depth: �� Height: f'
Square Feet; (/ Cubic Feet:
Type of Construction: :L2- Gee Estimated Cost: $
To Be Completed: 42 ]'
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in stfict 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 thi, application
are true and correct. '--7
DATE: S ' --) - :2 'Q SIGNATURE:'� �14,;
(See Reverse Side For Additional InformatioC.)
Y
1
�
Y
AppllM ion for Power Phuft and HeallaS Cooling, Vemnattne Robigeratlioa and
Air Comlifioning Sydem and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
RATZ TOTAL
Furnace Shell & Duct Work ....... I ........
.. $10.00 $
Replacement of Furnace
6.00 S
Repairs & Alterations—up to $500.00
6.00
Repairs & Alterations each add. $500.00
3.00
MECiL WARM AIR
Furnace Shell & Duct Work to 120,000 BTU .....
. $10.00 ;
each add. 60,000 BTU ....................
.. 3.W i
Replacement of Furnace
... 6.00 ;
Repairs & Alterations—up to $500.00
6.00 ;-
Repairs & Alterations each add. $500.00 .... ..
3.00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 $.--
Furnace
. _Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 10.00
Each add. 200 sq. ft. EDR Steam 3.00 ;
Each add. 320 sq. ft. IDR Hot Water 3.00
OIL BURNER—to 3 gal. per hour
6.00
$ _
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 189,000 BTU)
6.00
over 189,000 BTU Be* Fee Schedule
GAS FITTING FEES:
NO RATE TOTAL
1st 3 Fixtures .. . .....
x$ ?.W
$- A�
Additional Fixtures
x .79
$
Gas Range to 199,000
xi 500
$
AIR CONDiTIONiNa
$
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM
$
ALTERATIONS & REPAIRS
TOTAL FEE
$
ROUGH
FINAL
(SURCHARGE $_M)
l� S
Dept. of Bldgs. Phone 560-3490
Ate/
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct,
Fridley, Minn- 2
Owner
Kind of Building
Used as
To be completed about
Estimated Cost,
Old—New. Building Permit No. Permit No. v�fJ O
DESCRIPTION OF WORK
HEATING or POWER PLAm7s-.Steam, Hot Water, arm Air No
Trade NameL AI d o x Size No—GLJ
Capacity$ g�Sq. Ft. E.DR.#as wu H.P.
Total Connected Load-�7_ &' �� Kind of F.
BURNER — Trade Na.,ne Size No
Capacity Sq. Ft. E.DR BTU Hip
(REMARKS -OYER)
SIARVRRAIV
Signed � I cR®�01 rIONIN� C A�
MINNESOrA s, ,
By -
Business Phone No
9"
City of Fridley 111000
Application for Plumbing and Gas Fitting Permit r�
Dept. of Bldgs. Phone 560-3450
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures Location fO
y
�i
i�
?j;ai Z 1aZ
°CZ
�Z
O�
J
!2
WU'
�U'
i
•
P
•
N
WATER HTR.
GAS
EIEC.
p
uJ
Base
/
1st
IdEd
3rd
4th
• Future Connection Openings
��®cted wi3h
New Fixture, Old Openings I
Sewer ❑
Cesspool El
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... x 40 $
Future Fixture Opening ................ x 1*p $ 3.00
New Fixture Old Opening ......... .... x 1.00 $
Catch Basin .... x 3.25 $
Water Heater (Up to 200,000 BTU) ......—� x 3.00 $ ®o
New Ground Run Old Bldg. x 3.25 $
GAS FITTING FEES:
1st 3 Fixtures ..........................
Additional Fixtures ....................
Gas Range to 200,000 BTU ..............
REPAIRS & ALTERATIONS—Refer to Code
NO. RATE TOTAL
-60
— x $'t69 $
— x .50 $
— x 2.00 $
Description ................................................$
TOTAL FEE $U�
City of Fridley:
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the feel
and representations stated in this application are true and correct. //����,,
EFridley, Minn 19,C�
Owner 's/yr/+�'.� ey/%d 4(A22tP
Kind of
Used as
To be completed about 7' 10
Estimated Cost, "Oe
MlB---New. Building Permit
ROUGH
FINAL --q 7 �i
M
Business Phone
C&U- .
A
0
01,
SUBJECT
City of Fridley
P�1'7
7 7 3
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RE NO.
`L _ ____ COMMUNITY DEVELOPMENT DIV.
T
D
r PROTECTIVE INSPECTION SEC.
�1d
1 i �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
T PAGE OF
APPROVED BY
612-571-3450
910-F15
10/22/84
JOB ADDRESS 6036 - A Street N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
S32 4,5
7
1 Hyde Park SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Marcus Eichinger 6036 - 2h Street N.E. 571-6360
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Advent Custom Hames Inc, 350 Little Canada Road 55117 4832007
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
B DESCRIBE WORK
and sheetrock plus 3/4 bath
9 CHANGE QF USE FROM TO
STIPULATIONS
�3EPERACE PERMITS REQUIREU FOR WIRING
HEATING, PLUMBING AND SIGNS.
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 HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
AND KNOW THE SAME E TRUE AND C T. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES�G ERNING THIS PE OF WORK WILL BE COMPLIED
$10,000
$5.00
WITH WHETHER'SPp"'IFIED HEREI OR NOT. T E GRANTING OF A PERMIT
DOES NOT ESI3ME TO GIVETHORITY VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISION QJ'" ANY OTHER ATE OR CAL LAW REGULATING CON -
$80.50
STRUCTION THE OR NCE O ONSTRUCTION.
F
�r
PLAN CHECK FEE
TOTALFEE
$85.50
SIGNAT EOFCONTR OR OR HORIZEDAGENT I(DATE)
HEN PROPEZY VA 4TED TjHIS IS YOUR PERMI
SIGNATURE OF OWNER IIF OWNER BUILDERI (DATE)
BLDG INSP E
01,
NEW [ ]
City of Fridley Effective 4/1/84
ADDN. [ ] �R-1 AND R-2
ALTER. Building Permit Application
Construction Address: 20.36
Legal Description: _
Owner Name & ddress: Gu t Tel. # 5%1'6360
Contractor: U e`rr Cu f O Dire e -S � C Tel . r�8
Address: 3SU 4•t -
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
q. Ft.
s aI�
OTHER:
.L
04 S a
ROC.
Corner Lot [ ]
Inside Lot
Ft. Yd.
Setback Side Yard Setback
`
OG
Type of Construction: Pf/120
6 1 c quo
Estimated Cost:
$
Approx. Completion Date: ss
Proposed Driveway Width If New Opening Is
.k
DATE: � ?
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS•
APPLICANT:
Alt. A Alt B
$ $
Page for Explanation
Tel. -200
Fee Schedule on Reverse Side
25% of Building Permit Fee
$.50/$1,000 Valuation
$425 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
SUBJECT
PER
City of Fridley
7193i65
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
R
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
7 9p ��
i CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
•_--�/�" �
L 612-571-3450
910_F15 _
3/30/88
/
JOB ADDRESS 6036 - 211 Street N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
Sh 4&5
7
Hyde Parti
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Sharon/Marcus Eichinger 6036 -- 21 Street N.E.
571-6360
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 ❑ ADDITION ❑ ALTERATION 1 REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House (26 Squares)
9 CHANGE OF USE FROM. TO
STIPULATIONS
Roof can be the 2nd layer but not the 3rd.
MUMNXXXXXI4
install ridged galvanized. valleys.
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
1
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
$1,300
$.65
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONSTSOF ANY OTHER STATE OR LOCAL LAW CON-
$22.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$22 .65
UTRORIZEDAGENT (DATE)
SIG T RE OF CONTRACTEa/
WHEN PROPERLY
THI IS YOUR PE MIT
nVjDTED
p
JC!
SIGNATURE OF OWNER IIF OWNER BUILDER, IDATEI
BLDG INSP
BATE
NEW [ ] City of Fridley Effective 14/1/86
ADDN. [ ] �R-1 AND R-2
ALTER. Building Permit Application
Construction Address:(
Legal Description: d
Owner Name & Address:
Contractor
Address:
M
Ir
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
GARAGE AREA: Length Width
DECK AREA: Length Width
OTHER: j21A-,k-,a�dn o o �
Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback
4 �o
Type of Construe ion: lei �� Z% /�-S S
Approx. Completion Date:
Proposed Driveway Width If New Opening Is Desired:
Height
Height
Hgt/Ground
Tel. # _17/-e6360
Sq. Ft.
Sq. Ft.
Sq. Ft.
Side Yard Setback
Estimated Cost: $
Alt. A Alt B
See Back Page for Explanation
DATE: APPLICANT: - CJ ^ ? Tel. #
CITY USE ONLY
Permit Fee $ Fee Schedule on Reverse Side
Plan Check $ 25% of Building Permit Fee
State Surcharge $ ,�oS $.50/$1,000 Valuation
SAC Charge $ $ 550 per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $
STIPULATIONS:
SU9jEtT
PER
City of Fridley
2 9 0 7
AT THE TOP OF THE TWINS
BUILDING
PERMIT
`
• COMMUNITY DEVELOPMENT DIV.
EIPT N
/�
_
r PROTECTIVE INSPECTION SEC
/,
NUMBER
REV
DATE
PAGE OF
APPROVED BY
IL� ,.� CITY HALL FRIDLEY 55432
L ___-612-571-3450
910415
3/25/99
JOB ADDRESS
6036 2 1/2 Street NE
I LEGAL
LOT NO.
I
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
Sj 4 & 5
I 7
I Hyde Park
SHEET
2 PROPERTY OWNER MAIL ADORES$
ZIP PHONE
Markus Eichin er 6036 2 1/2 Street NE
571-6360
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Town & Country Roofinja 7910 12 n
854-9365
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
20091282
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION REPAIR O MOVE O REMOVE
X
8 DESCRIBE WORK
Reroof House & Garage 29 S Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday
thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
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
SO. FT
CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 80 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
1
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WQRK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2,485
$1.24
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-
$74.75
Fir$2.48
STRUCTION OR HE PERFORMANCE OF CONSTRUCTION
22C
PLAN CHECK FEE
TOTA FEE
Li e C
$
A83.47
SIGNATURE F CON'RACTOR OR AUTM R12E0 AGENT IDAA1
HEN O
A IDAT
is. IS Y R PER ma-
•
I
S,GNATURE Of OWNER OF OWNER BUROERI - IOATEI
9L0 IN SP
TEAT E
Mar -19-99 11:25A
NEW []
P.16
Effective 1/1/98
ADDN [ j CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R,1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: to
Legal Description: I Fin (' 0�1�V t [ (- ` ("o ` 77 - n,,,
Owner Name & Address: ! c;,, r' 11 u's 67/C.-/1 i ri A � r ' fiML Tel. #
Contractor: MN LICENSE /12
Address: / �— Tel. #
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:
Construction Type: Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DA'C'E: APPLICANT: Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
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 [ ]
503
Y OF FRIDLEY INSPECTION DIV.
31 University Ave NE
Q iley, MN 55432
a •3) 572-3604. FAX (763) 571-1287
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
RAAov wu KRACCO nC CIYTt 101te TA QC MOTAI 1 cn f1N CAf`w to f1f1R
Effective On Jan 1. 2003
-UMBING FIXTURE RATES: NO.
RATE
TOTAL
Wash
x Floor
,
> Auto.
-.` Gas
ate
Water Heater
Stories
:,yam'+
:.:. Urinal
:. x>: Shower
FIGI�
i r Tray�w
Drain
;s Washer
; Range
.- : Gas Elec
ow Off Basin
..-;.
�"°`�'
-?• - :iz-
- >-a
� � � sem:
��?se��-- • d
--`- -'. _
Q
Basement
$ 7.00
.20103
_ow
urnp/Receiving Tank
$ 7.00
-
'L�1it14d/L lug -Ell —b&44)
Floor 'f
:�-x...• :�.,..
,,. ��°
' :�.' :.
Y
w�::
. ..
- . .-
1w elt
Floor Z
xuc[:. ILx": V•.:;::
3cc�`
Y�x
pE LC.
i.
.,x>atY;
.si•
�.:.A...:. •Y.
:���:�`�`
Y..n<Q
'4.ee ES
:-�::. --'g3i'..'
P>�%.. _:
:LOT3: expo,... Y;
azeP.Y. �, >.
.s'!lI JORJYf:.
'w�f--'na
??!. ntlx
-: •: �Ya:.. _,
Floor 3
;:x3'•��-<"_
:p; ���><?
7R:..F�`.ii';i<'�-�
:;��.
� 'zx '
:' :<�>�
•:-.:.
�� :�
�:��
`:
xx::=: - • .
yF �!e�:::
�
v...'.c:dwt:..•.
Type
,�,��>-.3
M?:�<�j��
+::-i��?= > :au
v: x.
:J.v�t.?'Y yK•
,."
..,: -1
.-.u-2iirg�F�t»X�:
::<,:....•.x.�>
Floor 4
SIGNED BY
kLL OTHERS AND/OR REPAIRS AND ALTERATIONS
Fm
1.5% of Value of Fixture or Appliance
-UMBING FIXTURE RATES: NO.
RATE
TOTAL
JOB ADDRESS � e_� 03 (9
- aw Fixtures
$ 7.00
The undersigned hereby makes application for a permit for the work herein
id Opening, New Fixture
$ 4.00
specified agreeing to do all work in strict accordance with the city codes
:er Dispenser
$ 5.00
and rulings of the Building Division, and hereby declares that ail the facts
ow Off Basin
$ 7.00
and representations stated in this application are true and correct.
atch Basin
$ 7.00
Q
ain Water Leader
$ 7.00
.20103
_ow
urnp/Receiving Tank
$ 7.00
'L�1it14d/L lug -Ell —b&44)
Jater Treating Appliance
$10.00
OwnerShoifcy�'t --
Jater Heater -Electric
$ 7.00
1w elt
Dater Heater - Gas" �_
$10.00
Building Used As in
las Range"
M.000
1 � `7
gas Dryer"
$10.00
Estimated Cost 0 PERMIT NO. (�
rack Flow Preventer Required ( )Yes (} No
AA n.
`1)4& U
Type
$15.00
PLUMBING COMPANY Ivt
r
TEL NO. /f`03,
Zeinspection Fee $47.0011 -Ir
SIGNED BY
kLL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
'ab.0-0
- Approved BY�L Rough -In Date Final Date
State Surcharge
$ .50
MINIMUM FEE FOR ANY PLUMBINGiGAS PERMIT 1S $20.00
TOTAL FEE
$•_ j,'50
PLUS THE E.60 STATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE