PRE 2010 DOCSC�
City of Fridley, Minn.
BURDING PERMIT
Date: ...�.–...� �. .- -.T .............
Owner .......................................
Address......................................
N® 3950
LOC TION OF BUILDING
No. I.L1 /, Street ..... Part Woft ........... ...Lot .... ..... Block .... ......... Addition or Sub -Division......... ... .....
q�, / .q,...,,
Corner Lot ............ Inside Lot .X......... Setback 3.:%.�'- Sideyard .l.�..L�. a
DESCRIPTION OF BUILDING
;T' be Used, .. ... Front �(?..� Depth 14.: I4. ~Height /Y. 0` Sq. Ft. Cu. F't.'/;/.9, 7
Front ........ Depth ...... Height ........ Sq. Ft. ........ Cu. Ft. ........
Type of Construction......... �O
.......... Fit. Cost.. �• ..�...... To be Completed ..............:....
In consideration of the issuance to me of a permit to construct the building desribed 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 $./.4........, 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 with-
in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. —
:. Building Inspector
d' 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.
City of Fridley
Application for Plumbing and Gas Fitting Permit
DESCRIPTION OF WORK
Number. Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
ATO.
RATE TOTAL
Number Fixtures ......................
Number
G x
$1.50
T; ,
$�—
Future Fixture Opening ................
x
1.20
$
New Fixture Old Opening ..............
x
1.00
$
Catch Basin ............................
x
WATER HTR.
$
ELEG
Water Heater (Up to 200,000 BTU) ......--�
x
2.00
$
New Ground Run Old Bldg . ............
x
3.25
$
GAS FITTING FEES:
0O
P
N
GAS
$1.50
$ /111'0
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
Base
1st
2nd
/
3rd
_
4th
• Future Connection Openings
Connected withI Sewer �
New Fixture. Old Openings
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
ATO.
RATE TOTAL
Number Fixtures ......................
Number
G x
$1.50
T; ,
$�—
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
$ /111'0
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description.SS
...................................TOTAL FEE $
Dept. of Bldgs. Phone SII 4-7470
Location o' eZ-a -, /i/
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 D E C 7 1959 19
////—
Owner !� /'7' -Are z, .4 eza /:3 L -D A `5
Kind of Building / '
Used as !y
To be completed about �®
Estimated Cost, $
Old—New. Building Permit No %� Permit No.
signJaOND®N PLUMBING CO;
By—
ROUGH DEC 16 1959
FINAL
az 2M 7.59
Business Phone
•
City of Fridley, Minn.
BUILDING PERMIT
Date: July 91, 1965
N? 8161
i
Owner: R. Larson Builder Kyllo Construction Company
Address 6031 lith Street N. E. Address 6824 Oakland Ave. South
01
LOCATION OF BUILDING
No. 6031 Street - 4th Street N. E. Part of Lot
Lot 9 - Block 3 Addition or Sub -Division . Bonny Add.
Corner Lot _ Inside Lot
Sewer Elevation
To be Used as:
Type of Construction
Setback Sideyard
Foundation Elevation
DESCRIPTION OF BUILDING
Front Depth height Sq. Ft
Front Depth Height Sq. Ft
Est.cost UP 150 z0 To be Completed
• Storm Damage repajw
•
Cu. Ft
Cu. Ft.
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 fgith and in compliance wlt¢ all provisions of
ordinances of the city of Fridley. /J /
In consideration of the payment of a fee of 10"00 , permit is hereby =an
llo Constr. Coo
to construct the building or addition as described abois granted upon
the express condition that the person to whom it is granted and his agents, emplmen, 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 g location, construction, alteration, maintenance, repair and moving of buildings
within the city limits ns permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
Allen Jensen Building inspector
NOTICE:
Ibis permit dux not corer tho cendrudion, hutallaflon for vArb& p1 mbing, gx boding, sewar or water. N sura to we
the NOW Importer for separate pwm6s for those harm.
•
•
C�
C *1irI or YRKD)LET
31 Univegoity hkwjmw X.E,,
TridIey" Rinne@®t & $3421
Saptembeir 30, 11965
Kyllo Construction Company
6824 Oakland .Avenue South
Minneapolis, Minnesota
Res Building Permit No 8161
031 - th Street N. .
Paid
Centbns
it has ba@c)e a girw#a ames@Lty, to hwe your permit9s ported
c• -a your buiildLus duTing c@Wnuation.
W uld yon kindly @me In end pick up y@mg' pendt@
Lawdlatalyo
r
t
---
V. A
14
a
APPLICATION FOR B ING PERMIT
CITY OF,FRIDLEYO NNESOTAf
OWNER'S NAME �ER'
ADDRESS -31GESADDS
LOCATION OF AtDING
-� <
No. ,. � Street cart of Let .
Lot 9 Block _ Additiow or Subdivisi®n
Corner Lot_, Inside Lot __„SetWatk Side -Yard .
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to thin form, Two Certificates of,Survey of Lot and ..proposed build-
ing location drAwn on these Cattificates.
IPTION OF BUILDING
io be used 8s:
Front,
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu.. Ft.
Type of Construction Estimated Cos
_ Xo-be �ompl eted
The undersigned hereby makes application fora 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.
+-Scbedul.e ,of Fee Costs can be found on ;the Reverse Side) .
Xl-'
0.
r w
SUBJECT
PER
City of Fridley
® 13781
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RECEIPT NO.
`L _ COMMUNITY DEVELOPMENT DIV.
I INSPECTION
r � PROTECTIVE SEC.
1 �
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
`
CITY HALL FRIDLEY 55432
,'J
612-560-3450
910-1715
9/27/76
JOB ADDRESS 6031 - 4th Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
9
3
Bonny Addition SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Richard Larson 6031 - 4th Street N.E.
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
f NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 24' x 24' Garage
9 CHANGE OF USE FROM TO
T—
STIPULATIONS provide a hard surface driveway. FRIDLEY ENGR.
7HE
NO�� CURB
REGARDING
OIV1SION REGA CEMENT
REPLA
REMOVAL AND
OPENINGS.
AT DRIVEWAY
SEPWIM � PERMITS REQUIRED INS wOUNk ,
HEATM PLUMBING _AND �tGN: • , .;
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
wood Frame
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
5760
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
R-1
576
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.
$4,262.40
$2.13
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
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$23.04
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$25.17
SIGN TUREOFCONTRACTOR ORAUT RIZEDAGENT (DA EI
W)ENP OPY A ID ED THIS IS YOUR PERMIT
a
q_� ?(
BLDG INSP DATE
S149NATtDVAER BUILDER) IDATEI
NI
o ""7
SJO>►2A1nf � sl�aulDU]
'SNI ' ON073A119N3 Nl/9?.ingns, —P v -v ,. civ
Tiap - s aui �9 pa`ia��ns 5y pua/ pias uo ,to uwj' fiao j,' sluawgPna-m a a/9/5'1'1 pa pup ' uoau;y{ ` 54i'mn9
puo'puo; pa9r✓asZY aa,
*oga L,o sal.uapunoq ay/,P hiaA.rns DJO uq lV fuasalda.1 12aI-'m puo an -q o si s yf /vy/ fijljiag Agafay /
n
z
Ile
-d 'Qr%
J
JFO OIXITWETIE401a3
s�o�ian.�n 3 sjaaulku j
S ,
tyosavur`y •O N I ` vJ 1 I V "43N I O N bra/sad Sans
%t s�tc%3uur/y liu,��,rnr pern]
mfSI'ddspfwoIrMjj(lj-l//lW
bums"%/ punt
1
AGREEMENT
0
I, MMOL. owner of the property
located at ®,� V iN T /V, , have no objection to the
City allowing the construction of a %Q //y-- (y- to be
located at Q ;; fj/?� �%, /� �� without the required
certificate of survey that the City ordinarily requires for all new
construction.
ign ure
Address
z 71ro
Date
6- -) Lll� /j
Witness
l,i I r yr rnLULLT
APPLICATION FOR RESIDENTIAL ALTERATION,
ADDITION, OR REPAIR BUILDING PERMIT
OWNER'S NAME. L/4/ ka BUILDER.,
ADDRESS : ,�j� �� % DDRESS :
NO:. ® l STREET:
LOT: BLOCK: ADDITION:
CORNER LOT: INSIDE LOT:_SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
Front: c-�2 Depth: Height:_ `
Square Feet: 6_7� Cubic Feet: /(�®
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: Estimated Cost: _$ "�`EZa:d)�
To Be Completed: t -�c� - �� �� .2&.2. "/0
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: rJ_A(A-- SIGNATURE : /,-0? GGA/�,/ �.( /��✓// 1 ---
(See Reverse Side For Additional Information.)
�3.0�1
a..3
SUBJECT
P/
City of Fridley
2 1 6 4 2
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
PT NO.
_ COMMUNITY DEVELOPMENT DIV.
L
PROTECTIVE INSPECTION SEC.
NUMBER
REV JIDATE
PAGE OF
APPROVED By
CITY HALL FRIDLEV 55432
612-571-3450
910-F15
11/09/92
JOB ADDRESS 6031 - 4th. Street
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
9,10
4
Hyde Park SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Collen Larson 6031 - 4th Street Fr' 571-3563
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Elk River Exteriors 19365 Lander St Elk River 55330 441-7240 0004457
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Dwelling
7 CLASS OF WORK
❑ NEW ❑ ADDITION j] ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reside house
9 CHANGE OF USE FROM TO
STIPULATIONS
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
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
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
$7,469
$3.73
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$99.00
Fire Sc- 7.47
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
Lic SC - 5.00
$115.20
I.
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI
HE PROPERLY VALID TED THIS IS YOUR PERMIT
BLDG INSP BATE
SIGNATURE OF OWNER) IF OWNER BUILDER) IDATEI
UrfY OF FR'110L F 7
PDN I
NOW 9 P.
Ti
fEL:
- -, I-i��-1� -
l
PAGE 03
9:16 0
4,Iov"' `,SZ. rUICUIVUN.001 P.Q3
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXIiS R-1 AND X.2
vcmk Applicatit"I
e'aruqtracfiun Address'. �
oon__
r i.
L
I , j9 Descripik Tel. #
()wtw N=,',,:- & Addursis: �e,
- g) .- _Uf ',
C-OnV4 i.7 I MN U(:ENS1; #CQ2.!j
AZ�Cy) t Tel. # 7
t. -C
Anach to NS applicatimk, a Certif"Clate Of SurveY of the
lot, with the proposed con Anwion dfawu On it ttl Scab,
j)E,SCjtIpTI(yN OF ItAPROVEIALINT
uvimARFA7 Leogth Width Hcight Sy. Ft.
G
GAR -AGE APPA- URK(h Width Height Sq. Ft.
PMK ARFIA. Ungth Width Hgt/Ground Sq. Ft,
C
'Orrje,r JAt Ft. Yd Setback Side Yard Setbacks
j -7 H
Type Of COUSUUction, _�L Estimated C-O.A:
,*p - pox, CoaVv4don Date'.
.K
(cost on Back)
VnWway Curb Cut W-Idth NeedM' Ft. +
Tel. #
DA -T& APPLICANT: L14LA_
0111 OMA
tit Fer q
�q,00_ Fee Schcdutc un Reverse Side
Fin Surcharge $ __7, q2 __ .001 of Permit Valuatiol, tl/Wth%)
SUIA $urcharge S S-5041,000 valu,"',wfl
SAC Chargc $___ $700 per SAC Unit
Licopse Surchtwgt, $ —S.DO .00 $5.00 (State UcensoJ Kcsidential Lontractuu!i)
Drive -way Escrow $ Alt. "A- or Alt. '8" AbOV0
ft;* +CC FDcwrauncd by Eagine-Cri,19
$ Fee
6eww Main chaf-ge $_ Agreement Ncccssary i 1 Not Nemmq ( j
TOTAL
$TIVULATIONS:
/ , 0
sue.iEtT
PE
City of Fridley
2 7 892
AT THE TOP OF THE TWINS
BUILDING PERMIT
i
O
COMMUNITY DEVELOPMENT DIV.
____
r � � PROTECTIVE INSPECTION SEC.
/jam
101,
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEV 55432
L 612-571-3450
910-F15
I
9/21/98
JOB ADDRESS 6031 4th St NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
9
3
BonneyAddition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
fakiNzx Larson
571-3563
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
American Roofing & Const 23624 St Francis Blvd St Francis 55070 753-7451 20109395
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 O ALTERATION 21 REPAIR
O MOVE O REMOVE
B DESCRIBE WORK
Reroof house & garage (22SQ) Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED 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 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
1 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
$39710.00
$.94
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
$59.50
Aire SC $1.88
PLAN CHECK FEE
T A FEE
Lice C 5.
$67.32
Si UR wCON-R RO I A T DATEI
HE PR VALI
iD THIS "UR ERMIT
t
NATURE Of OVVNERIIF OWNER BUILDER( (DATEI
OG Nspr
DAfE
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: (p o 3 t C(A d fi—
Legal Description:
Owner Name & A dress: (, 1Tel. # '�- —7
Contractor: MN LICENSE # % o -Z�
Address: 7� ��� 7 c S Q �� 'Cz�c _ Tel. # —7
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF BOROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
J.
Construction Type:. Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = x = $
DATE:APPLICANT: Tel. # ZEL
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee $
Sewer Main Charge $
TOTAL
. STIPULATIONS:
$ 23a-
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 [ ]
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Effective On January 1, 1999
PLUMBING FIXTURE RATES: NO.
RATE TOTAL
New Fixtures
$ 7.00
Old Opening, New Fixture
$ 4.00
Beer Dispenser
$ 5.00
Blow Off Basin
$ 7.00
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Water Heater —Electric
$ 7.00
Water Heater — Gas** /
$10.00 to -v o
Gas Range**
$10.00
Gas Dryer**
$10.00
Back Flow Preventer Required ( )Yes () No
Type
$15.00
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge $ .50
TOTAL FEE $ 96.5b
JOB ADDRESS i�C 3 r '-/tR S7' A-/65
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.
Owner eGi1-4s-e-A/ zA1zS0Aj
Building Used
Estimated Cost
d
.1999
PERMIT NO. 12S__�16
PLUM BING COMPANY
SIGNED BYTEL N0.
Approved By Rough—In Date Final Date
"191
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES.