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PRE 2010 DOCSPermit Fee paid on Permit #11,315 for 1560-1570 69th Avenue N.E. City of Fridley, Minn. -11330 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERMIT Mate: W ebru.Rrsr_.22; 1972 Owner: —Rice Creek Development Company I Builder Approved Contractors,, Inc.. Address 85 West Road, Circle Pines, Minn.Address 1052 Osborne Road N.E., Fridley 786-3680 1673,167521677, LOCATION OF BUILDING Na 1679,1681,A 68th Avenue N.E. part of Lot Parcels 100, Section 13 lot Block Addition or Sub -Division CorBer Lot Inside Lot Setback __._.____ Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Each Unit 6 Towlthouse Units Front 2 0 1 Depth 32' Height 21' Sq, Ft. 1213' Ca. Ft. Front Depth �+ Height Sq. Ft. _— Cu. Ft. Type of Construction -_ Wood Framp Est. Cost a7pP #11. 31 5 To be Completed 1 year In consideration of the issuance to me of a permit to construa the building described a , I agree to do the proposed work in accordance with the description above s rth and;1n co lance provisions of Ordinances of the city of Fridley. In consideration of the payment of a fee of $ See 111. 31permit is hereby granted to 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 m, 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 . ncee city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordina S CE BELISLE NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sura to we the Building Inspector for separate permits for these items. Application for Power Plaids sed ideating, Cooling, Yentilattn. Ra1Eiger�ation and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: MTN TOTAL Furnace Shell & Duct Work ..... .. $10.00 $ Replacement of Furnace ... 600 $ Repairs & Alterations—up to $S00.00 6.00 $v Repairs & Alterations each add. $500.00 3.00 $—__ _ MECH. WARM AER pp Furnace Shell & Duct Work to 120,000 BTU ... ..CO ..$10.00 100 each add. 60,000 BTU .................... . 3.00 i Replacement of Furnace .. .... .. ... too $ Repairs & Alterations—up to $500.00 6.00 $ Repairs & Alterations each add. $3W.00 .... 3,00 $ 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 6,00 $ over 3 gal. per hour --See Fee Schedule GAS BURNER (up to 199,000 BTU) ...... ca . &00 $—'30--0-0 over 199,000 BTL) See Fee Sehedule Dept. of Badge. Phone SW -M s.We« City of Adley: 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. Owner Kind of Building y, l ,. To be completed about -- �,"/_ Estimated Cost, $_.—___... -- Building Permit No, 1W 2 Permit No.�8 DZB=PTI0N OF WORK HEATING or PO PLANTS—Steam, Hot Water, f ��No-L Trade Name— (!��� Size No- - �� � off' GAS FITTING FEiD: NO RATE TOTAL Capaeity o D O Sq Ft E.DR BTU g r 1st 3 Fixtures x$ 200 $L • 0 0 Total Connected Load Kind of Fuel Additional Fixtures a .75 $ BURNER — Trade Nam Size No Gas Range to 199,000 a; 5.00 ; 00 capacity Sq. Ft. EDR- 8Tl ]31�! AIR C01fDITEONIIIG Co 6 �� FAN HEATING SYSTEMSas Foo Schedule VENTILATENG SYSTEM D V . U 0 ALTERATIONS & REPAIRS TOTAL FEE - U v 7-q f s`' ROUGH d. FINAL e F (REMARKS—OYER) �l City of Fridley AppOcutioe for Phi and Goy R"htq ftm* Dept. of Bldg& Phos 560-3450 `� DESCRIPTION OF WORE, % t,3 S - i `77 - I ') _ L S' 1 Number. Kind and Location of Fixture � L� L� � ' i 1 ! i i C ? r i� 3 8 11-13(13,11 e . • M wArre wee. c,�s nct Base f® 1st 7 to kw `I 3rd 4th • Future Connection Openings • Now Firdure. Old Openings Cemaeaad whit s.war ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ x $2.00 5� Future Fixture Opening .... :...... x $1.80 New Fixture Old Opening .......... x $1.80 5 Catch Basin .................... x $3.26 S Water Heater :Up to 99.000 BTU) .... x $3.00 = New Ground Run Old Bldg......... x $3.25 S Electric Water Heater .............. a 52A0 $ GAS FITTING FEES: NO. RATE ,TSOT,A�L�� lot 3 Fixtures x 5800 i� Additional 173rtnrea ............... x $ .76 i Gas Range to 199.000 BTU ............ x $5.00 6 State Surcharge $ .50 REPAIRS ! ALTERATIONS—Rater to Code Description TOTAL VEE 5� /-2 (,r, . 4-?) City of Fridley: The undersigned hereby makes application for a permit for the wort[ hetet• specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings6 and hereby declares that all the fact' and representations stated in this application are true and correct Fridley. Hien Owner LIE 'er I'� C C R IP 16, Kited of HuU»g di l C sa; , �c :� S Used as t To be completed about o= Estimated Cost. _ Old—New. Building Permit No. Permit No. Sign L� - z e By Business Phone No`tea ,.r .-- ROUGE -2 S SUBJE& P City of Fridley 31459 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. __ ___ r � � PROTECTIVE INSPECTION SEC. 1 ; � 1 /"'1 CITY HALL FRIDLEY 55432 �'' NUMB Eq REV OAT E PAGE OF APPROVED BY " 612-571-3450 910415 10/10/00 JOB ADDRESS 1673, 1675, 1677, 1679, 1681, 1683 68 Avenue NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Parcels 10 & 200 Section 13 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jim Bern Co 8162 Bloomington Ave S, Bloomington, MN 952-854-7788 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO BE$ Exterior Maintenance Corp 405 W 60 St, Mpls., MN 55419 612-861-6243 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Townhouse Building 7 CLASS OF WORN ❑ NEW ❑ ADDITION ❑ ALTERATION j] REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof 6 Unit Townhouse Building (53 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 BO 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 6 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 $5,419 $2.71 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTIdEERSTATE OR LOCAL LAW REGULATING CON- $.125.25 Fire SC $5.42 STRUCTION ORT F CONSTRUCTION X:511 PLAN CHECK FEE TOTE 00 $,73 .38 TUR FCON'AACTOAOgAUTMOpIZEDeGENT IOATE, EN ROPE ALIDAT IS IS YOU PERMIT / BLO iNSo gaiE $-GN4TUAEOFDWNEniIFOWNER BU4DERi iDATE7 Prepaid Plan Check $ Estimated Cost $ Receipt # Construction Address Legal Owner & Address CITY OF FRIDLEY R-3, COMMERCIAL & INDUSTRIAL BUILDING PERMIT APPLICATION Effective 1/1/2000 (612)572-3604 Zoning Tel# (75,;L)6p (-.j 7 a CONTRACTOR & ADDRESS % Y/�'~ /ml,'%'10fn6'�'-c !3 Tel# y'0 G✓� (� DF S� f �.S Baa✓✓ ��l � Architect TYPE OF WORK [] New Reg.# Engineer. BUILDING CONSTRUCTION [] Addition [] Alteration -Describe Reg.# �3 'Cl(K ) T rd Building Use Construction Type Occupancy Group Air Conditioning [] Yes [] No Fire Protection Provided [] Yes [] No D—formance Bond Amount $ See Reverse for Schedule Received []Yes []No Permit Fee Plan Check $ Fire Surcharge $ State Surcharge $ . SAC Charge $ Erosion Control $ Park Fee $ Spec. Assessments $ Driveway Escrow $ TOTAL $ PERMIT FEES See Fee Schedule on Reverse Side In Excess of Prepaid Amount - See Reverse Side .001 x Permit Valuation (1/10th W) $.50/$1,000 Valuation (See Schad. 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 OFC. AREA: Length Width Height Sq. Ft. WHSE AREA: Length Width Height Sq. Ft. OTHER AREA: Length Width Height Sq. Ft. APPLICANT A # ( �a ' I' Tel AJ � Date VALUATION Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) _ $ Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) TOTAL VALUE Building Use Construction Type Occupancy Group Air Conditioning [] Yes [] No Fire Protection Provided [] Yes [] No D—formance Bond Amount $ See Reverse for Schedule Received []Yes []No Permit Fee Plan Check $ Fire Surcharge $ State Surcharge $ . SAC Charge $ Erosion Control $ Park Fee $ Spec. Assessments $ Driveway Escrow $ TOTAL $ PERMIT FEES See Fee Schedule on Reverse Side In Excess of Prepaid Amount - See Reverse Side .001 x Permit Valuation (1/10th W) $.50/$1,000 Valuation (See Schad. 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 Lill Ur thJULLY. APPLICATION FDR PLUMBING AND GAS FITTING PERitr. Job Address 16 7 Department of Buildings City of Fridley Tel. 1571-3450 The undersigned hereby mazes applicatiaa for a permit for the work herein specified agreeing to do all work in stric, accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this--&pplication are true and correct Fridley, mn- / , 19F OWNER Rx'%TE SCnEr'u"L E - PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures S 5.00 $ suture Fixtures S 3.50 S Old Opening, Now Fixture $ 1.50 S or ._ _ C . • u - x u Creeh Basin Mater - a ■ d yy 5.00 L -. r O -J- --a. --�_ 4. c _— Heater S Macer Treating Applianze S 7.00 S yn $ 5.00 S Cas Range S 10.00 S r � ■ 10.00 t � ^ = 0 Appliance _ —S Reinspection Fee S State Surcharge - S .50 O y aJ Jt a C � i• -. 7 O Q q Y N� J :A a 10 H 1. 9 "•�• J t ',. –� • O' 7 a' 'Ii y 1 N V m ui s a in v m < = t �i o .as ec -let - 3rd -- 4th (R) - Future Connection Opening Connected with Sewer (') - New Fixture, Old Openi-n Mater Rx'%TE SCnEr'u"L E - PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures S 5.00 $ suture Fixtures S 3.50 S Old Opening, Now Fixture $ 1.50 S -- Beer Dispenser _ --_: S 4.00 $ Blow Off Basin S 5.00 $ Creeh Basin S 5.00 $ Pain Wetar Leader S 5.00 $ Hydraulic Valve $ 5.00 $ SuAP or Receiving Tank S 5.00 S Macer Treating Applianze S 7.00 S Hot Water Rester $ 5.00 S Cas Range S 10.00 S Gas Dryer S 10.00 S ALL OTHERS AND/OR REPAIRS AND ALTEP.ATIONS 1% of Value of Fixture or Appliance _ —S Reinspection Fee S State Surcharge - S .50 (S15'.00) TOTAL FEE KIND OF BUILDING USED As --- TO BE COMPLETED ABOUT ESTInk EO CCST OLD NVW BUILDING PER`tIT NO. r£?h:T NO. Company Signed By [D Tel. No. %L -IL kc-u:.H INSP. Date FINAL INSP. Date AFP"OVAL FOR PEI,'1IT MINIl304 FEE FOR ANY PLLMBINC, PERMIT IS $10.00 PLUS THE S.50 STATE SURC)lAkGE City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287 6431 University Ave NE Fridley MN 55432 Mechanical Permit # dbbS- 0)073 j Residential Application City of Fridley See Back Side For Required Information Date Site Address: �% The applicant is: (cidre one) Owner Contractor Properly Owner: Address 4J:_ City: " eGt&i; State: �W Phone: Cell: Fax: Contractor Informati n - Company Name. Contact Person: Address: 4 City: 009� zaz�' State: /LIA/ zip: Phone: V W&I MeT Cell:61,& x/90 Yom_ Fax: !'owl K Email: a MN Bond# & Exp Date Type of Work (circle one): New Replacement Alteration/Remodel Detailed Description of work: gv 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 to Air exchanger $15.00 _Furnace $35.00 _Pool Heater.$35.00 _Air _Boiler $35.00 _Gas Dryer $10.00 Ventilator $15.00 ._ Chimney Liner $10.00. Gas Piping $10.00 _r 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 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 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 case of all work which requires review and approval of plans. Signature of Applicant: Dater / . ®� Approval Inspector Signatur Please Note: Separate permits are required for Building, Plumbing, and Electrical work 117 DATE J1 SITE ADDRESS 13:34 CITY OF FRIDLEY PLUMBING RESlQENTJALAEELW&M*j, City ®f Fridley P. 02/04 ,:;,?o®r 01S,,q� Permit Number Received By Date Received IF PROPERTY IS NOT OWNER/OCCUPIED- A LICENSED CONTRACTOR MUST OBTAIN THE PERm.T. /Z__ - THE APPLICANT is: (CIRCLE ONE) OWNER CONTRACTOR NAME PROPERTY OWNER/ TENANT ADDRESS CITY STATE -Zip PHONE # NAME ®, ENSE # CONTRACTOR ADDRESS Z `7 vo j61kZAA t5�__A_ CITY 4_rSTATE /f AJ ZIP PHONE # FAX#�i PERMIT TYPE SINGLE FAMILY TWO FAMILY TYPE OF WORK 0 NEW le REPLACEMENT DETAILED DESCRIPTION OF WORK FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED FDCTURES: (INDICATE TOTAL NUMBER OF EACH) BATH SINKILAV FLOOR DRAINS BATHTUB GAS PIPING (Need City License) CLOTHES WASHER KITCHEN SINK DISHWASHER LAUNDRY TRAY Permit Pee $__25, Plan Review $ Surcharge $ .50 TOTAL DUE $ -?S- , SHOWER WATER PIPING SWIMMING POOL WATER SOFTENER ($35) —,PATERCLOSET BACi(FLOW PREV. ($fs) WATER HTR ($35) FOR IRRIGATION WATER METER OTHER MINIMUM:- $15.00 or 5% of -cost of the improvement -whichever is - greater on work less than $300 Make checks payable to: City of Fridley ...w — —' iss- r �4_. a wA. rVR h rC►%1Y11 1 - nv 1 V AULJ UN-IIL 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 pPns. NAME OF APPUCANT �° 1"14 DATE Z Jj Pl se type or print SIGNATURE OF APPLICANT OF FRIDLEY COMMUNITY DEVELOPMENT 5EPAR1 6$31 UNIVESITY AVENUE NE, FRIDLEY. MN 55432 RUG -09-2005 13:34 CITY OF FRIDLEY P.03iO4 City of Fridley Building Inspections Dept, Ph: 763-572-3604 FAX: 763-571-1287 6431 University Ave NF Fridley MN 55432 Mechanical Permit # Cts-. r58`9 Residential Application City ®f Fridley See Rack Sidra Fnr Rantiirad lnfnrmn*:nr% Date Site Address: The applicant is: (cirlce one) Owner Contractor Property Owner. Address: City: State: Zip. Phone: Cell: Fax: Contractor InformaV �I � N , Company Name: Contact Person: Address:Z City: State: Zip, Phone:_ ! (16-elU li4 cell: 617 g® ZP,517 Fax: Email: 1 4 ancth• MN Bond# & Exp Date Type of Work (circle one): New Replacement Alteration/Remodel Detailed Description of work O —*-&& 11/1. 19Gam• 4�11 A& ZZ,(/Zr% ra 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 _AIC $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 w Gas Piping $10.00 Duct Work $10.00 Gas Range/Oven $10.00 Permit Fee b� (Total from above -Minimum fee $35.00) Surcharge $.— ... _-.. . _ ...... 0:50 .--_ . - - __:. _ . -.. . .. . Total Due $ Make check payable to City of Fridley E ms 25 an appuCarton Tor a permit• not vans until processed 1 hereby apply for a mechanical permit and 1 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 Codas; 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 Appli Approval Inspecto From: unknown Page: 1/2 Date: 8/18/200812:32:04 PM Bullding PLUMBING � Permit Ne Inspections RESIDENT'LA.L "PLICATION Retmived By. 763-572-3604 763-502-4977 FAX CITY OF F RMLEY DATE SITE ADDRESS 7 7 THIS AMYCANT TS; O 0WN1M C TOR PROPERTY XAMB- TENANT ADDRESS: I co 12 i PHONE:. 1 $ 4 ©`� •T CONIMAC WR NAME. p - Dey ��►. S err u. C. SUBMrr A COPY OF YOUR STATE �rA7E ucENSE tl S$� '� r – kJOP DATE _ LICENSE, BOND AND STA7B BOND # . XF DATE CERTIFICATE OF ADDRESS: �,`tSa0 a 7*1- AyG AJ c" �,�STATE 19 A/zrn ssyf7 INSIMANCIy PIIONB _._ �6 3 s a •g -FAX `++�� d! -7 PERrar Typic xa SINGLE FAMILY O TWO FAMILY TOWNHOUSE TYPE OF WOM 0 NEW *"I ACM W DETAILED D ON OF WORK ! ' rre, . .Pr PER NIS 1611.665 the permit fee is a minimum oT x15.00 or 5% of the total cost up to*$SO-00, wtdclwver is greater, for the improvcMW% installation or replacement ofa, nerd denial fixture, excluding the fixtures. (Mia. should reflect only the cost of labor) Labor cost under $300 = $15.00. Labor cast bet%-een $300 to S500,, cost of 1$bor __,x.05 plus .50 surcharge OR FOR PROJECTS WHERE LABOR WxCEEM $s9, FEES r.RE BASED ON St0.00 PER FIXTURE„ ExCEPT W iE;.M NOTED. FI)MIRES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $1 S.50. _ BATH BBRULAV FLOOR ARAIN3 _ SHOWER_ WATER PIPING _ BATH7UB — OA3 P1P.rPT(i (p MED CrIT LIC) _SWIVIMI{+TG POOL WATER SOFTINER ($35) _ _CLOTHES WASH®! —Krl SIM: _WAT®tCLOSET _RACIMLOWPREV.(SM -DISHWASHER LAUNDRY TR 4Y HEATER (5351 POR ItRIGA 1'tQN T�WATER !6, WATER A2ti1'19R —OTHER PERMIT FEE PROJECTS FOR UNDER $500 K PJI#fT FEE FOR PROJECTS OVER $500 Permit Fee $ �/"t-, . CS�, Number of fixhu es @ $10.00 x $10.00 = $, Surcharge Number of fixtul es @d $15.00 x $15.00 = $ Ott Number of fibchrt es @ $35.00 x $35.00 = $ TOTAL DUE $ I S . 1 $.15.50 State Surcharge = $._-._ 5 wdINIM[lNI $15.50) Total a $ THIS IS AN APPI.MAT IOwFOR A vmuor--NOT VALID UNTIL PRa O.:3M I hereby apply for a plumbing permit and 1 acknowledge that the information above is conal lete and accurate; that the work will be In conformance with the ordinances and odes of tht City of Fridley and with the Minnesota Ci mu&mction 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 v I site; that the work will be in accordance with the approved plan in the ca of all work vvk chh%requires review and approval of plans. 0 58341- 00k4 SIGNATURE OFAFPLTCANT rG�.���-.'---.PRINTNAME I�JC'1,' �� It,•, _L- -A D� DATES -i9 -0 APPROVED BY -- DATE PLEASE NOTE! SEPARATE PERMUS AIM M2LUED FOR BUTLDTNa BLECT:f!JC:AL AND MECHANICAL WORK City of Fridley Buff4ft. Inspectians Department 6431 Unhusity Avenue NE, Fridley, MN 554.32 763-5723604 FAX: 763-502-4977