PRE 2010 DOCSPermit Fee paid on Permit. #11,315 for 1560-1570 69th Avenue N.E.
City of Fridley, Minns 13 4 `
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT -
Date: February 22, 1972
owner: Rice Creek Development Company Builder Approved Contractors, Inc.
Address 85 West Road. Virc l -p- Pines, Minn. Address1.052 09ho a Road NF ,, Frid ay
168231680,16783 LOCATION OF BUILDING
No.1676$16743]72 68th Avenue N.E. part of Lot
Parcels 10 2&0, Section 13
Lot _ ._.. to _ Addition or Sub -Division _
Corner Lot ___._.. _ _ _ Inside Lot Setback Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as: Each Unit
6 Townhouse Units—_ Front 20t Depth 321 Height 21' Sq, Ft. 1213' Cu. FL
Front — Depth Height Sq. Ft. Cu. Ft.
Type of Construction —.. Wnnd Frame Est. Cost Sep d411,315 To be Completed I year
In consideration of the issuance to me of a permit to construct the building described ab%we, I agree to do
the proposed work in accordance with the description above set and in compliance all provisions of
ordinances of the city of Fridley. Z&Z
In consideration of the payment of a fee of $ See #11, 315permit is hereby granted. t, Rice Creek Dev. . Co.
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 ordingmces of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildi�i$�
'Within the city limits and this permit may be revoked at any time upon violation of any of the provisions of Said
ordinances.
CLARENCE BELISLE"
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to an
the Building inspector for separate permits for these items.
Application for Power Plank and Heating, Cooling, VORNationa RsfEigewatioe and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIA: RATE TOTAL
Furnace Shell & Duct Work ................ .. $10.00 $
Replacement of Furnace ... ..... ..... .. &00 $
Repairs & Alterations—up to $500,00 6.00 $_
Repairs & Alterations each add. $500.00 3.00 $—__
MECIL WARM ADI
Furnace Shell & Duct Work to 180,000 BTU .... 6.
..$10.00
each add. 60,000 BTU ....................
.. 3.00
$
Replacement of Furnace .. .. . ....
6.00
Repairs & Alterations—up to $500.00 ..
6.00
$
Repairs & Alterations each add. $500.00 ....
&00
$
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam
$10.00
$.
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. EDR Hot Water
3,00
$_
OIL BURNER—to 3 gal. per hour 6,0D $ _
over 3 gal. per hour—See Fee Schedule _
GAS BURNER (up to 199,000 BTU) ..... 6., . &00 6 6
over 199,000 BTU See Fee Schedule
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures _ e x$ 2.00
Additional Fixtures x .75 $
Gas Range to 199,000 2$5.00 $
AIR CONIDiTION ING �p L 0 `
FAN HEATING SYSTEM Sao F» Se>iadula
V ITILATING SYSTEM 9,
ALTERATIONS & REPAIRS ! TOTAL FEE . U
M K I Sa
ROUGH
FINAL Z / J'"'
/h
r �o
c;2
Dept. of Bldga. Phorw 5W4=
0%/O.��
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 Ordivancef
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Owner
Kind of Building
Used as
To be completed about _ 47 2 %
Estimated Cost,
Ol New uilding Permit No. Permit No. _ �� Y2
DESCRIP'PIOX OF WORK
HEATING or POY9M PLANTS. -steam, Not Water, -No_hC
Trade Nam Size x0 r®.V2 — __L2__
Capacity Sq. FL E.D.R BTU H.P
Total Connected Load Kind of glee
BURNER — Trade Name Size No
Capacity Sq. FL E.D.R BTU ISP!
s
Business Phone Nrs 9A,1 CJ
(REMARKS -OVER)
C 1fy of FricHey
P1 adfon for Pkmbbg and Gag Whig Pmt
Dept. of Bldg& Phone_ 860.3430
DESCRIPTION OF WORE
Number, Kind and Location of Fixtu"a
Base
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RTES-
NO. RATE
TOTAL
Number Fixtures ................
x $2:00
:
11 �
�
=
E,
®�
� 1
;
:
�
D q
WAM
GA4
RM
Base
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RTES-
NO. RATE
TOTAL
Number Fixtures ................
x $2:00
:
Future Fixture darning .... :......
x $1.60
=
New Fixture Olaf Opening ..........
x $1.60
i
Catch Basin ....................
x $3.26
$
Water Beater •.11p to 99.000 BTU9....
x- $3.00
g• o
i�
New Ground Run Old Bldg.........
x $3.26
$
Electric Water Heater ..............
x $2.00
$
GAS FITTING FEES.
NO. RATE
TOTAL
lat 3 Fixtures .............. . ...
` /'P x $2.00
$
Additional FIxture a ................
x $ .76
$
Gas Range to 190,000 BTU ............
x $6.00
$
State Surcharge
$
.50
REPAIRS a ALTERATIOND—Refer to Cedo
_!
Description o ....... o . .... . s .... w....
.. l .... .
M
�./.y....�..*.. y.....
TViAL fu
City of Fridley:
/6 2 R- - O6 re —/6
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 ruffling of the Department of Buildings. and hereby declares that all the fact
and representations stated in this application are true and correct
Owner
Find of Building
Used as
Fridley, Mina / I9_
To be completed about
Estimated Cost, $
Old—New. Building Permit
ROUGH
�—
'
SUBJECT
P
City of Fridley
3 2 8 01
AT THE TOP OF THE TWINS
BUILDING PERMIT
E,
NO.
E _____ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
1 � �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
i "..-I CITY HALL FRIDLEY 55432
A
._-•
L J` 612-571-3450
910415
7/18/02
JOB ADDRESS 1672-1682 68th Ave NE
I LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
Parcels 10
& 200
Section 13
SHEET
2 PROPERTY OWNER MAIL ADORES$ ZIP
PHONE
Rice Creek Townhomes / Jim Bern Management Co
952-854-7788
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Rayco Construction Co, 3801 5th St NE, Columbia Hts, MN 55421
612-547-3011
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
8 USE OF BUILDING
Townhomes
7 CLASS OF WORK
❑x NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR
❑ MOVE O REMOVE
8 DESCRIBE WORK
Re -roof (tear -off) - 52 squares
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with State Building Code
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAO
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 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
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
$5,573.88
$2.79
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
PVISIONS DF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$ 125.2x7
Fire SC $5.57
S UCTION OR THE PERFORMANCE OF CONSTRUCT I N
PLAN CHECK FE
TOTAL FEE
` ®
Licen 5.00
$1 .61
S"GNATUR OFCONTRACT OR AUTNORiZED AGENT 10 TE"
HEN ROPE LIDATED HIS IS YOUR PERMIT
Lve
01
I �4/
S-GN4TURE OF OWNER OF OWNER BUILDER" tDATE,
. BLD iNSP JWSATE
Prepaid Plan Check $
Estimated Cost $
Receipt #
CITY OF FRIDLEY
R-3, COMMERCIAL & INDUSTRIAL
BUILDING PERMIT APPLICATION
Effective 1/1/2000
(612)572-3604
p 14% 39A /
Construction Address !� - l (P� _ (� Zoning
Legal le- U e-
�'-
Owner & Address 7:S7a(h &/A Tel#
CONTRACTOR & ADDRESS
' IJ�y
ESS �pt�y � ��� � � G Tel# (CQI�) r) -
Q
Architect NIA Reg.#
Engineer.
Reg.#
BUILDING CONSTRUCTION
TYPE OF WORK [] New [] Addition [] Alteration -Describe_ 0-f-4- +`f -
OFC. AREA: Length
Width
Height
Sq. Ft.
WHSE AREA: Length
Width
Height
Sq. Ft.
OTHER AREA: Length
Width
Height
Sq. Ft.
APPLICANT � �
1 ► \�� �a/�
Tel #_-A-SLIT)
Date � I � ®"=
VALUATION
S S9 3.
Sq. Ft. x $
Cost/Sq.
Ft. = Valuation $
)
Sq. Ft. x $
Cost/Sq.
Ft. = Valuation $
) _ $ I,, I30• oo
Sq. Ft. x`$
Cost/Sq.
Ft. = Valuation $
) TOTAL VALUE
Building Use Ous�NV\0n\e,
Construction Type Occupancy Group
Air Conditioning []Yes
[]No Fire
Protection Provided []Yes
[]No
Performance Bond Amount
$
See Reverse for Schedule
Received []Yes []No
Permit Fee $ kaws'D-s-
Plan Check $
Fire Surcharge $ J.5
State Surcharge $,`1�
SAC Charge $
Erosion Control $
Park Fee $ , 00
Spec. Assessments $
Driveway Escrow $
TOTAL $ `�J� •fir
PERMIT FEES
See Fee Schedule on Reverse Side
In Excess of Prepaid Amount - See Reverse Side
.001 x Permit Valuation (1/10th C
$.50/$1,000 Valuation (See Sched. for > $1 Million)
$1100 per SAC Unit (Plans to MWCC for determination)
$450.00 Conservation Plan Review
Fee Determined By Engineering
Agreement Necessary [] Not Necessary []
feet x $15.50/foot
ATTACH STIPULATIONS
97 -8h -L16051 CITY OF FRIDLEY ,
• APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
PARTIAL RATE
SCHEDULE
PLUMING FIXTURE RATES:
NO.
RATB
b
Number Fixtures
x
$3.00
U
Future Fixture Opening
u
0
$
Water
x
$2.00
$
v ..r4
m.
$5.00
$
y
o,
w
$
100,000 BTU to 199,000 BTU
Heater
a
U
A
H
$7.00
$
H
'� ani
b
N
c! C
We
$5.00
•� $
J
6
u
ani
a
u
vi
c� w°
w
u m
u
o
as
lee
oAa
.
1�
2nd
3rd
1
1
17-7(R)
. Future Connection Opening
Connected with Sewer
(•) - New Fixture, Old Opening
Water
PARTIAL RATE
SCHEDULE
PLUMING FIXTURE RATES:
NO.
RATB
TOTAL
Number Fixtures
x
$3.00
$
Future Fixture Opening
x
$2.00
$
New Fixture, Old Opening
x
$2.00
$
Catch Basin
x
$5.00
$
Water Heater - to 99,000 BTU
x
$5.00
$
100,000 BTU to 199,000 BTU
x
$10.00
$
Water Softener
x
$7.00
$
New Ground Run Old Building
x
$5.00
$
Electric Water Heater
x
$5.00
•� $
GAS FITTING FEES:
lit 3 fixtures x •$3.00 $
Additional Fixtures x $1.00 $
Gas Range to 199,000 BTU x $10.00 $
REPAIRS $ ALTERATIONS
First $100.00 $5.00 $
each add. $100.00 or fraction $2.00 S
State Surcharge $ .50
TOTAL FEE $ 8.00
REINSPECTION FEE
Job Address 1682 68 Ave. NE '
Department of Buildings
City of Fridley
Tel. 0571-3450
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 Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn. 10-30-7 , 19
OWNER rnDv1 ,UUn1
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT 11-6-78
ESTIMATED COST 20.00
OLD - NEW BUILDING PERMIT NO. PE
0
Company _ MINNEGASCO
Signed By .
Tel. No.
ROUGH INSP.
Date
FINAL INSP.
Date �—
APPROVAL FOR PERMIT '
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 puU $.50 STATE SURCWu=
C,
City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287
6431 University Ave NE
Fridley MN 55432
Mechanical Permit # 46c��- 39�
Residential Application
City of Fridley
See Back Side For Required Information
Date Site Address:
I
The applicant is: (cirl a one) Owner Contractor
Property Owner:
--
Address: 1,946 49Zg%&a1
City: -,a �
State: AW Zip: A9%M
Phone: Cell:
Fax:
Contractor Inform ati n -
Company Name: Gl�
Contact Person:
r
Address:
City:/"Ze:- State: && Zip:
Phone: 6" 4,'64,0' Meer Cell:A(&
Wo Fax:
G1�a
Email: a
MN Bond# & Exp Date ,:X o
Type of Work (circle one): New
Replacement Alteration/Remodel
Detailed Description of work: /?I- 4W
L%���i , 1'il.��
0Q,9tv -�
dam%/' �•
Equipment Installed: MFG:
Model: Size/BTU:
MFG:
Model: Size/BTU:
MFG:
Model: Size/BTU:
Please check all that apply: _Fireplace
(gas) $15.00 New Gas Grill $10.00
A/C $25.00 _Fireplace
(wood) $35.00 _Gas Unit HTR $10.00
_Air to Air exchanger $15.00 _Furnace
$35.00 _Pool Heater $35.00
_Boiler $35.00
Gas Dryer $10.00 _Ventilator $15.00
_Chimney Liner $10.00. _Gas
Piping $10.00
Duct Work $10.00
Gas Range/Oven $10.00
Permit Fee $
(Total from above -Minimum fee $35.00
Surcharge $
0.50
Total Due$
Make check payable to City of Fridley
Q
This is an application for a permit- not valid until processed Z?
1 hereby apply for a mechanical permit and I acknowledge that the information above is complete and I
accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and F�
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; that the work will be in accordance with the
approved plan in case of all work which requires review and approval of plans.
Signature of Applicant: Date:
Approval Inspector Signatur Dater 15?_gzS
Please Note: Separate permits are required for Building, Plumbing, and Electrical work
AUG -09-2005 13:34
/V
CITY OF FR I DLE`(
PLUMBING
RESIDENTIAL APPLICATION
City of Fridley
®s-` 0/c0
Permit Number
Received By
Date Reoeiv�
NOTE: IF PROPERTY 13 NOT OWNER/OCCUPIED- A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT.
DATE YOUR §MAIL ADDRESS
STrE ADDRESS 2
THE APPLICANT IS: (CIRCLE ONE) OWNER CONTRACTOR
NAME
PROPERTY OWNER/
TENANT ADDRESS
CITY sTATE ZIP
PHONE 0.
NAME® i �J CENSE N 2 ,�
CONTRACTOR ADDRESS Z '7 va
__4 0 &" 0,
CITY AZZ, STATE /kAJ ZIP �®
PHONE 4rlFAX##
PERMITTYPE SINGLE FAMILY TWO FAMILY
TYPE OF WORK 0 NEW Er' REPLACEMENT
DETAILED DESCRIPTION OF WORK
rs
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED
FIXTURES: (INDICATE TOTAL NUMBER OF EACH)
---BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING
BATHTUB GAS PIPING (Need City License) SWIMMING POOL WATER SOFTENER ($35)
CLOTHES WASHER KITCHEN SINK ATER CLOSET BACKFLOW PREY. ($is)
DISHWASHER LAUNQRY TRAY WATER HTR ($35) FOR IRRIGATION
WATER METER OTHER
Permit Fee $ 5 6� MINIMUM: $15.00 or 5% -of cost of the Improvement-whichevei. is -
Plan Review $ - greater on work less than $300
Surcharge $ ,50_
TOTAL DUE Make checks payable to: City of Fridley
THIS IS AN APPLICATION FOR APERMIT —NOT VALID UNTIL PROCESSED
1 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; that the work will be in accordance with the approved plan in the case of all work which
requires review and approval of p s_
NAME OF APPLICANT ,f.✓dv? 41M(/ _ DATE dg J_J
PI se type or print
SIGNATURE OF APPLICANT
631 UNIVESITY AVENUE NE, FRIDLEY. MN 55432
AUG -09-2005 13:34 CITY OF FRIDLEY
P.03/04
City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287
6431 University Ave NE
Fridley MN 55432
Mechanical Permit#
Residential Application
City of Fridley
See Back Side )Fnr Qpn/IIYAri Infnrm!%t;nn
Date Site Address:
The applicant is: (cirlce one)
Owner Contractor
Property Owner.
Address:
City:
State: Zip:
Phone:
Cell: Fax:
Contractor InformatN
Company Name:
Contact Person:
Address-
City:
OfState: Zip:
Phone:_
Cell: 6!3 !,9® 9Pq'? Fax:�s�
Email:s 4 al /7, C4 MN Bond# & Exp Date
T e of Work (circle one):
New Replacement Alteration/Remodel
Detailed Description of work
IV
Equipment Installed: MFG:
Model: Size/BTU:
MFG:
Model: Size/BTU:
MFG:
Model: Size/BTU:
Please check all that apply:
_Fireplace (gas) $15.00 New Gas. Grill $10.00
V/C $25.00
Fireplace (wood) $35.00 _Gas Unit HTR $10.00
Air to Air exchanger $15.00
_Fumace $35.00 _Pool Heater $35.00
_Boiler $35.00
_Gas Dryer $10.00 Ventilator $15.00
_Chimney Liner $10.00
►/Gas Piping $10.00
Duct Work $10.00
Gas Range/Oven $10.00
Permit Fee
b�a
(Total from above -Minimum fee $35.00)
Surcharge
Total Due
Make check ppyable to City of Fridley
u nis i$ an appucation Tor a permit- not vaua unto processed
I hereby apply for a mechanical permit and I acknowledge that the Information above is complete and
aerate; 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 apprication
for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in case of all work which requires review and approval of plans.
Signature of App
Approval inspector
Date:=jc`
Building MECHANICAL Permit No.. q1 66
Inspections COMMERCIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date 2 2 2 1
763-502-4977 FAX I EFFECTIVE I-1-08
DATE_ ' o - 6 � YOUR E-MAIL/ADDRESS
/• �/
/
SITE ADDRESS �(� �Z -
THIS APPLICANT IS: ONTRACTOR
PROPERTY
Npp,�:
ADDRESS: CITY STATE ZIP
OWNER/
TENANT
PHONE: CELL: FAX:
CONTRACTOR
COMPANY NAME: '
NOTE:
SEPARATE CITY
CONTACT PERSON: -!2!7--dSa !GyilJ
LICENSES ARE
STATE BOND # EXP DATE:
REQUIRED FOR GAS
/'/-
2-442_8 C�i(IW% CITY L �FSTATE_&A/ZIP 502-3
AND HVAC.
ADDRESS:,1�
PHONE• S/"f�9 �8 CELL: �17 �d'' 2.3��AX: �0�� ��� ZS -O6
SUBMIT COPY OF BOND
AND INSURANCE
CITY GAS LICENSE # CITY HVAC LICENSE # EXP:
PERMIT TYPE
ULTI-FAMILY ❑ COMMERCIAL ❑ INSTITUTIONAL ❑ CONDO ❑ INDUSTRIAL ❑ SWIMMING POOL
❑ OTHER
TYPE OF WORK:
❑ NEW -)A/REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK:
EQUIPMENT INSTALLED MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE(BTU
MFG: MODEL: SIZEBTU
A/C DUCT WORK _ ROOF TOP UNIT (RTU)
_
BOILER RNACE _ REFRIGERATION
_
CLASS I HOOD � S APPLIANCE _ STEAM/HOT WATER HEATER
_
CLASS II HOOD GAS PIPING _ SWIMMING POOL
_ _
COMMERCIAL KITCHEN _ POOL HEATER _ OTHER
_
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATION: $,/ 5-6, oe,
PERMIT FEE $ 1.25% OF JOB VALUATION / MINIMUM FEE $35.00
SURCHARGE $ VALUATION x.0005 / MINIMUM .50
TOTAL DUE $ MINIMUM $35.50 Make Checks Payable to: City of Fridley
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a mechanical permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and cod7of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application forpehnit and o is not to start without a permit on site; that the work will be in accordance
with the approved plan in the case of all VOk w e uires rev' and approval of plans.
OF APPLICANT RINT NAME %C� ZDATE Z
SIGNATURE
APPROVED BY DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
)6