PRE 2010 DOCSLOCATION OF BUILDING
No.loto .. Street Sir. ,, .. Part of Lot .......................
Lot .. ....
Block ..... Addition or, Sub -Division .....................................
Corner Lot ,...:.. ..:.
Inside Lot
....:... ...,
..... Setback :.. ... Sideyard
..,..:...
To be Used as:
DESCRIPTION OF BUILDING
.
........ __tt�.
Front .' ..:.... Depth lieight .. ... Sq. Ft.........
Cu. Ft........ .
................ .
IIII
Front ........ Depth ........1 eight . .. Sq.
...... Ft.
........ Cu. Ft........ .
Type of Constructio
; r
Est, Cost,%: !!R.. To be Completed .A! ,.W
L2 consideratio
the proposed work
ordinances of the v
of the issuance to me, of `a permit to 1, construct the building described above, I agree to do
i accordance with the description -above set forth and in compliance with all provisions of
age of Fridley.
In ognsideration Df the payment of a fee of> $:.:. t s h by granted to :..... .
to construct the building' a n:: d ed above. grante8 upon 16Wits
conditio that the person to whom it is ed and ' agents,employ and wor en, in all work
done in, around and upon said building, or any part thereof, sh conform in all to a ordinances of
Fridley, Minnesota arding 'location, construction, alteration, maintenance; repair and moving of buildings with-
in the village limitsd this permit may be'revoked at, any time upon violation of any of the provisions of said
ordinances. I / /1
r
Building Inspector
NOTICE:
This permit dlDee not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. sure to see the Building Inspector for separate permits for. .these Items.
y
Apowflon for Power Plants -and Heating. Coobng. Ventdation..ReMgemlion tind
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SII 4-7470
GRAVITY WARM AIR: RATE TOTAL, Location-
Furnace
ocailo 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 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 60,000 BTU .................. 2.00 $
Replacement of Furnace §.00 $
Repairs & Alterations—up to _$500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 .......:...... 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 $ S- O 0
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
ROUGH
FINAL
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 true and -correct.
Fridley, Alin 19 �� E
Ow.nan.. _
"ct,of Building
Used -aa
To be'ompleted about
Estimated Cost, $ a,
O.
ew. Building Permit No. Permit No.
DESCRIPTION OF WORD`: _ --
HEATING or POWER PLANTS --Steam, Hot Water, Warm Air—No
Trade Name Size
Capacity Sq. Ft. E.D.R BTU H.P.
Total Connected Load Sind of Fuel
BURNER — Trade Name Size No— cam/ P
Capacity Sq. Ft. E D.R- RH.P.
Sign
By
42 7M 7-59 Business Phone No6
(REMARKS -OVER)
560-3450
City o Yrdley
w
ANOKA COUNTY
6431 UNIVERSITY AVENUE NE FRIDLEY, MINNESOTA 55432
August 10th, 1976
Mr. $ Mrs. Jerry J. Blesi
681 -58th Avenue NE
Fridley, MN 55432
Dear Mr. & Mrs. Blesi:
Earlier this year, the City was contacted to review a drainage problem
in the easement that runs along the north 5 feet of all the properties
along 58th Avenue NE. Our initial survey indicated that a natural root
growth of the large tree in your rear yard, by your north property line,
was creating a minor obstruction to the natural flow of runoff water.
It was also found during recent follow-up surveys, that you have now
constructeda flower bed garden in your northeast corner which, conse-
quently, created an even bigger obstruction to the natural flow along
this drainage easement. Our survey indicates that potentially, 6 inches
of water.would back up into adjacent yards before continuing on to Monroe
Street.
In the common interest of your upstream neighbors and to protect yourselves
from any potential damage liability, we strongly urge you to relocate your
new flower bed outside of the 5 foot drainage easement and to cut a small
swale through the high spot created by your tree's root growth.
Should you need some survey information regarding the elevations your rear
yard should be restored to, please feel free to contact our office. Your
cooperation will be appreciated.
Sincerely,
CITY OF FRIDLEY
17 4040 X
Thomas A. Colbert, P.E.
Assistant City Engineer
TAC/grs
City of Fridley
SUBJECT
PE R Mi.
13789
AT THE TOP OF THE TWINS
BUILDING
PERMIT
jx&
r
`
ECEIPT
16 • COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 i �
1 /'-'1 CITY HALL FRIDLEY 55432
L-"�'� ,'�
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
"612-560-3450
910-F15
19/30/76
JOB ADDRESS 681 - 58th Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
18
4
1 Donnay's Iakeview Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Jerry B1esi 681 - 58th Avenue 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 ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
x
8 DESCRIBE WORK
Ccnstruc t a 221611 x 256" Garage
SEP ATE PERM! i 5 Rt.4' IRED HA U16l"Ai •
9 CHANGE OF USE FROM NTiA-nNj% PLUMBING AN /
STIPULATIONS Provide a hard surface driveway.
*— TANT--
6741nl7-* ewoe tAge47 ✓�7 ,fi r MM THE FRIDLEY EN 1
IMION REGARDING CU
ftne- /qW4C-/0ee' ,0 �/� � o
REMOVAL AND REPLACEIMi
AT DRIVEWAY OPENINGS
BAro digging +a11 local stili
TELEPHONE - ELECTRIC - C�tS i
-REQUIRED BY
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
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
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
R-1
578
5780
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 WORK WILL BE COMPLIED.
$4,277
$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-
$23.12
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$25.25
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
P P R Y LIDATED THIS IS YOUR PERMIT
4A z
M
BLDG (NSP
DATE
,PSreIGNAT RE 'OWNER IIF OWNER BUILDER( (DATEI
41'
as
It.
CITY OF FRIDLEY
APPLICATION FOR RESI DENTIAL BUILDING PERMITS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWNER'S NAME: l f u �� �� r —BUILDER:
ADDRESS: – ,i [/ C Alt-- ADDRESS : V L
TEL. NO.
NO:. 6-'e l STREET:
LOT : Z e� BLOCK : � ADDITION: "X,/ /V A
CORNER LOT: INSIDE LOT: SETBACK: SIMARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To Be Used As:
DESCRIPTION OF BUILDING
Front : 0? 2 G /� —Depth:
Height
Square Feet: .S_12P_i Cubic Feet: 15")cc! 6
Front: Depth:
Height:
Square Feet; Cubic Feet: l
Type of Construction: AB d �� P�/� /�i Estimated Cost: $ a J
To Be Completed: (' _ �� q�r/r�
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict 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: 3 b ' % 6 SIGNATURE
(See Reverse Side For Additional Information.)
,2 3 i-
wj�
;).i3
AGREEMENT / �I
!I
I, , owner of the property
located at , have no objection to the
City allowing the construction of a /P/47/'O f OSS1, xz,4` G%Nfhb' to be
located at G without the required
certificate of survey that the City ordinarily requires for all new
construction.
77--Lqig� 4 04kq
Signature
Address
�Z"- -717,�
Date
r
77--Lqig� 4 04kq
Signature
Address
�Z"- -717,�
Date
1
SUBJECT
City of Fridley
CE-t*W4-49—.1:—
AT THE TOP OF THE TWINS
BUILDING PERMIT
COMMUNITYDEVELOPMENT DIV.
en/j-�
r � � PROTECTIVE INSPECTION SEC.
1 ' �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
10/13/88
JOB ADDRESS 681 - 58th Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
18
4
Donnay's Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Jerry Bles.i 681 - 58th Avenue N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Normandale Services. Route #1, Isanti, MN 55040 444-6118
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 Ck REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Aluminum TriM/ Replacement window
9 CHANGE OF USE FROM 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
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
$3,000
$1.550
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$55.50
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY1 LIDATED THIS IS YOUR PERMIT
P
BLDG INSP f)AT
SIGNATURE OF OWNER IIF OWNER BUILDER)_ (DATE)
1
NEW I ]
AMN I[ ]
ALTER
Construction Address
Legal Description:_
Owner Name &
Contractor:
Address:
VA 0�.
City of Fridley Effective 5
R-1 AND R-2
Building Permit Application qn
J -<� T4
(L)"
TPJ.. #
Tel. # ff2-611 �
Attach to this application, a Certif icate of Survey of the
lot, with the proposoed construction drawn on it to scale.
DESCRIMION OF IMPROVIIMENT
Length Width Height Sg. Ft.
Length Width Height Sg. Ft.
Length Width Hgt/Ground Sg. Ft.
Corner Lot I ] Inside L I ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: t.� �� N Estr�'mated Cost:
FaceVoeV 7l
Approx. Completion Date: " �/
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
WidW + 6' °� See Back Page
DM: APDL IMV: ZO t i 9e1. # �`5" � 61106;
CITY USE ONLY
Permit Pee
$
State Surcharge
SAC Charge
$
Driveway Escrow
$
Park Fee
$
Sewer Main Charge
$
TOTAL
$ •� ��(
3t'IPMMIONS:
Free Schedule on Reverse Side
$.50/$1,000 Valuation
$550 per SAC Unit
Alt. 'A" or Alt. 'B" Above
Flee Determined by Engineering
Agreement Necessary I ] Not Necessary I ]
SUBJECT
P
City of Fridley
2 2 2 71
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
�` COMMUNITY DEVELOPMENT DIV.
_____�_
r V I PROTECTIVE INSPECTION SEC.
LIV
NUMBER
REV
DATE
PAGE OF
APPROVED By
CITY HALL FRIDLEY 55432
L 612-571-3450
910-F15
12/21/93
JOB ADDRESS 681 58 Avenue NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
18
4
Donnay's Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Jerry Blesi 681 58 Avenue NE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
D & D Home Improvement 7401 Central Ave NE, Fridley 55432 784-7543 4840
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
❑ NEW ❑ ADDITION ❑ ALTERATION $J REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Dwelling (22 Squares) Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
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
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
$2,2Q0
$1.10
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
Fire SC $2.20
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$5.0.0 License SC
$62.30
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
HEN PR07SPLWLYHLI ATED THIS IS YOUR PERMIT
gL INSP DATE
SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI
NEW [ ]
ADDN [ ] CITY OF FRMLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: 061'
Legal Description:
Effective 5/26/93
Owner Name & Address: ��f1��/Tel. # 6-7
Contractor: D & D Home Improvement, Inc MN LICENSE # 4840
Address: 7401 Central Avenue N.E. , Fridley, MN 55432 Tel. # 784-7543
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length
GARAGE AREA: Length
DESCRIPTION OF IlbiPROVEMENT
Width
Width
DECK AREA: Length Width
OTHER:
Height
Height
Hgt/Gramd
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: Estimated Cost: $
Approx. Completion Date: ���Z se4er!!!�`
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$ �2 loo
DATE: APPLICANT: Tel. # �5
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ -<q�
CITY USE ONY
Fee Schedule on Reverse Side
$ ��'
.001 of Permit Valuation (1/10th%)
$ !%
$.50/$1,000 Valuation
$
$750 per SAC Unit
$ �'"
$5.00 (State Licensed Residential Contractors)
$
Alt. "A" or Alt. "B" Above
$
Conservation Plan Review $450.00
$
Fee Determined by Engineering
$
Agreement Necessary [ ] Not Necessary [ ]
3j
$� STIPULATIONS:
N° 40510 f�
Building Job Report
ADDRESS f/ —
OWNER -
BUILDER
DATE �� „l(� (^ PERMIT NO.
DESCRIPTION
INSPECTION RECORD
QATE REPORT
r F` i (� r tl 11 J � r"� .�(, 1• y1�i � l 1 � `.', j !:7_ t_ � "
.)
. r
s
wM�
OWNER - REP. r^OLG{ 1�f ' PECTOR
Building PLUMBING
Inspections RESIDENTIAL APPLICATION
763-572-3604 CITY OF FRIDLEY
763-502-4977 FAX EFFECTIVE 1-1-08
DATE 6//,5-16 y YOUR E-MAIL ADDRESS
SITE ADDRESS $ S8 _
THIS APPLICANT IS: 0 OWNER UCONTRACTOR
p
PROPERTY NAME: f 14 Y I Ids je11✓ S I
OWNER/ ADDRESS: Cg 5' ( 58 CITY F-2 , L
TENANT PHONE• i L-3 5 i G 2 o 0
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
CERTIFICATE OF
INSURANCE
PERMIT TYPE
NAME:
STATE LICENSE #_
STATE BOND #
ADDRESS:
PHONE
0 SINGLE FAMILY
TYPE OF WORK: I 0 NEW
E
M
ATE M -)ZIP 5'f W32 -
Terry overacker Plumbing, Inc. —EXP DATE
502 E Main Street —EXP DATE
Anoka, MN 55303 STATE ZIP
0 TWO FAMILY 0 TOWNHOUSE
REPLACEMENT
DETAILED DESCRIPTION OF WORK
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00; whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x .05 = plus .50 surcharge
OR
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW). MINIMUM FEE $15.50.
WATER PIPING
_ BATH SINKILAV _FLOOR DRAINS _ SHOWER _
GAS PIPING (NEED CITY LIC) SWIMMING POOL _ WATER SOFTNER ($35)
—BATHTUB _ _
CLOTHES WASHER_ KITCHEN SINK WATER CLOSET _ BACKFLOW PREY. ($15)
_
DISHWASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
_ _
WATER METER _OTHER
` j]
...,, ...: 3h;'1K'AA v.._'_.. OOO i.
Ar
ry .5'n
Permit Fee $
Number of fixtures @ $10.00 x $10.00 = $
Surcharge J0
Number of fixtures @ $15.00 x $15.00 = $
OR Number of fixtures @ $35.00 x $35.00 = $
TOTAL DUE $
State Surcharge = $ .50
(MINIMUM $15.50)
(MINIMUM $15.50) Total = $
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 permit and work is not to start without a permit on site; that the work will be in accordance
with the approved plan in khacase of all work which requires review and approval of plans.
J��K ` -4 '^°�~DATE
SIGNATURE ICANT PRINT NAME
APPROVED BY - DATE
j. .; �a
stay
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977