PRE 2010 DOCSCity of Fridley
SUBJECT
® 146
AT THE TOP OF THE TWINS
BUILDING PER T
i
`
RECEIPT N
1. _-__ COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1
D
i ) CITY HALL FRIDLEY 55432
NUMBER'
REV.
DATE
PAGE OF APPROVED BY
612-580-3450
910-F15
5/4/78
JOB ADDRESS 1591-93 73rd Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
4
2
DeLeier Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Leier Inc. 519 - 3rd Avenue N.W. 633-4335
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESSS A'� PERMITS REQUIRED rVKE ,l,IR�I EGSENO.
6 USE OF BUILDING HEATING, PtUMBING AND SIGM-S.,
Residential
7 CLASS OF WORK
NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ MOVE
AAIAn NI;
8 DESCRIBE WORK
Construct a 44' x 24' Double and a 24' x 25' Garage Belore digging Call 10C&I u{111' is5
TELEPHONE - ELECTRIC - GAS Esc.
9 CHANGE OF USE FROM TO RE
STIPULATIONS provide a hard surface driveway. Provide sod in the front and side
yards. Provide a verifying survey before capping. Provide truss design
by May 30, 1978. Provide combustion air to furnace.
SAME HOUSE AS 1581-83 73RD AVENUE N.E.-PLAN FILED UNDER 014,217
Sewer Location: 50' W. of X0 Manhole (Inv. 887.12)
Wye Elev: 886.92 + 6' Riser
Top of Footing: Expose service. to establish top of footing elevation.
Water Location: 12" CIP 5' to 8' South of the No. line of 73rd Avenue.
MUST BE TAPPED TM CITY OF FRSDLE1l DOES NOT GUARANTIM THP
DRIVEWAY DEPRESSION COST: N/A
ACCURACY OF UTILITY LOCATIONS AND ELIEVATIONS.
t
0,0 ZJ48, 6 THIS DATA IS FOR INFORMATION PURPOSES AMv
.ONLY.
PERSONS USING R SHOULD VERIFY _ Tkg .jNFpRMATt0N
ON INE SITE
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
1114 + 61O
27,916 Tota
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
2
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,
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$35,815
$17.91
DOES NOT PRESUME TO GIVE AU ORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STAfN OR LOCAL LAW REGULATING CON-
STRU OR THE PE FOR AN E F CONSTRUCTION.
$111.66
$800.00
PLAN CHECK FEE
TOTALFEE
S957.49
PRO RLY VALIDATED THIS IS YOUR PERMIT
S ATUREO TONTRACTORORAUTHORIZED AGENT ATE)
-H�EyN
C BLDG INSP DATE
SIGNATU RE OF OWNER IIF OWNER BUILDER) (DATE)
CITY OF FRIDLEY
API'LICATIOEI -i OR E'E;SIUE NTIAL PERM 10
(1NE W, AL TE IMTIONS, ADDITIONS, OR IRE PAIRS)
01111-11R: 1 E --__ BUILDL•'R: �IA F7
Ad (Ir es f:: �� t L"N AddreLs :
Tel. No.
NO. Cj�Street:
LGT: DLOCK: _ �ADDITIOII: �
COENER LOT: —_-- INSIDE lr,JT: -�� SEETBACK:SIDEYARDES t 4Z -
Applicant attach "to this form Talo Certificatcs of Survey of Lot and proposed
building location drawn on 6hese Ccrtiiicates.
DESCRIPTION OF BUI LD1*NG
To Yc Used As:
Square Fret: Cubic Feet:
.25/
Height: ------
i
Depth: S� Height:
A
Square Feet: �� �_ Cubic Feet: �;_ � 6
i �Sr
a'Pe of Const—action: _ V� Esti.:nated Cust,:
To De Completed:
Alt. 11 Alt. r
Proposed Driveway Widt1-i If New Opening Is Desir � � $ _ $_ _
REVERSE SIDE OF SHEET)
The under signed hereby makes application for a permit for the work herein
specified, agrecing to do all work in strict accordance with the City of
Fridley or.dinanccs and rulings of the Dcnartmcnt of },uildirgs, and hereby
declares that all the facts and representations statcd in this application
a. -e true and correct. See reverse side for addiLional inforniaLion.
DATE: -4� SIGNAT:''70:
Stipulations:.
6OU s e its /S l -
13
'
Gs I. --V
'
1.
r
Address
2.
Legal / el
' 3.
Zoning -3
4.
Lot Width 74
5.
Building Width. IV
6..
Front Setback 3
7.
Total Use 1yr1a4VfI = 7L
8.
Lot Coverage6�?&
9.
Easements
10.
Variance.
11.
Soil,
12.
Contractor' JID ' L-cz� 6,
13 . •
Phone 6 S3 - 4e
14.
Architect 4-�
15.
Drainage
16.
Energy Ashrae .
17.
Utility Locations -"
18.
Specials
..
Driveway opening,..
Q,�
Truss Design
,W
Combustion Air
22.
- 23.
24..
25.
T
CITY OF FRIDLEY
6431 University N. E.
.Minneapolis Minn. 55421
612-560-3450
SUBJECT -ldfUnd-99 RjV-=-M DqPMGLM RSWW DATE SePtedbw 20p 2978
Vlam make a dum* Ja tliaramom"_ of 03MOO'A fAdw I=.* SU - 3rd
Avaim. ILW.,r am lhrjotmv m SSW. wil
paid cis W 4j, 1978* tbat via wt use& Ow mad an mdatLa
----- -------- . .. . .............. - - - ---- ... . . . .. ...... ......... . .
dicivanyt la nted at L"1-3593 73rd Avamto XX.
in Your
- A-4
for tim
DATE, SIGNATURE,
KWURN THIS COPY TO ORIGINATOR
• CITY 01= FRIDLEY ,
APPLICATION FOR RESIDENTIAL BUILDING I1I=11MITS
(NEW, ALTERAT.i n( , AUDIT 1 ONS, OR REPAIRS)
LF (,c- BUILDER* :
Address: Cf �,J JAddress:
Tel. No . 02 3 - 443
No.: A991- Street: `) 3- r2 0 X
LOT: BLOCK: c)- ADDITJON:
CORNER LOT: INSIDE LOT: SETBACK: SIDL•'YARDS:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To 13e Used As:
DESCRIPTION OF BUILDING
Front:
Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet: +
Type of Construction: Estimated Cost: $
7b 13e Completed:
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $
(SEE REVERSE SIDE OF SHEET)
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 i this application
are true and correct. See reverse side. for addi ial tion.
DATE: SIGNATURE:
Stipu ations: ,
U�� �CtSTl �.1 y 2522�
A?cc-
F
a7 9�o
10,
j
91
�J-
:-0w--�'�q-
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GA3 FITTING PERMIT
Job Address ) 73
Department of Buildings
City of Fridley
Tel. #571-3450
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
7� Fridley, Mn. C 9 — y� , 19
OWNER p U (=1 t`i2
KIND OF BUILDING 00 V �J 1? U q/ 6 A d �
USED AS
TO BE COMPLETED ABOUT
PARTIAL RATE SCHEDULE
a [
b+
PLUMBING FIXTURE RATES: NO.
Water
RATE
TOTAL
OLD NEW ILDING PERMIT NO. PERMIT NO.
It tuber Fixtures •�2
x
$3.00
$ -y O
Future Fixture Opening
x
$2.00
$
o.
w
Heater
Companj
New Fixture, Old opening
x
$2.00
k
a
Catch Basin
Ai
314°
u
'C
Water Heater - to 99,000 BTU `-
a`
$5.00
$ CSd
Tel. No. 'f,� Y S-& 2-
100,000
100,000 BTU to 199,000 BTU
x
$10.00
Water Softener
r.
$7.00
o
°
go
muhM�c
a
�
Wu
M
r
am7
..0�
a
m
ai
vi
Sn
s
w
.e
W
w
m
3
c�
�
as
lec
$10.00
$
APPROVAL FOR PERMIT /�
REPAIRS & ALTERATIONS
First $100.00
$5.00
$
each add. $100.00 or fraction
Oa
$
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATS SURCHAM
State Surcharge
2
?
TOTAL FEE
$ -4–b
2
REINSPECrI011 FEE
2
2
lst
Z
2nd
3rd
4 th
(R) a Future Connection opening
Connected with Sewer
M m New Fixture, Old Opening
Water
Job Address ) 73
Department of Buildings
City of Fridley
Tel. #571-3450
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
7� Fridley, Mn. C 9 — y� , 19
OWNER p U (=1 t`i2
KIND OF BUILDING 00 V �J 1? U q/ 6 A d �
USED AS
TO BE COMPLETED ABOUT
PARTIAL RATE SCHEDULE
ESTIMATED ST
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
OLD NEW ILDING PERMIT NO. PERMIT NO.
It tuber Fixtures •�2
x
$3.00
$ -y O
Future Fixture Opening
x
$2.00
$
Companj
New Fixture, Old opening
x
$2.00
$
i
Catch Basin
x
$5.00
• $
Signed By
Water Heater - to 99,000 BTU `-
x
$5.00
$ CSd
Tel. No. 'f,� Y S-& 2-
100,000
100,000 BTU to 199,000 BTU
x
$10.00
$
Water Softener
r.
$7.00
$
New Ground Run Old Building
x
$5.00
$
ROUGH INSP.
Electric Water Heater
x
$5.00
$
Date
GAS FITTING FEES:
FINAL INSP.
1st 3 fixtures '2
x
'$3.00
$d
' Date
Additional Fixtures
x
$1.00
$
Gas Range to 199,000 BTU
x
$10.00
$
APPROVAL FOR PERMIT /�
REPAIRS & ALTERATIONS
First $100.00
$5.00
$
each add. $100.00 or fraction
S2.00
$
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATS SURCHAM
State Surcharge
$ .50
TOTAL FEE
$ -4–b
.
REINSPECrI011 FEE
APPLICATION FOR
POWER PLANTS AND HEATING,
COOLING, VENTILATION, REFRIGERATION AND
.AIR
CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
,
GRAVITY WAIM AIR:
RkTE
TOTAL
Job Address 41�1
Furnace Shell s Duct Work
$12.00
$
,
Replacement of Furnace
Repairs s Alterations -up to $500.00
7.00
7.00
$
$
Department of Buildings
Repairs 6 Alterations each add. $500.00
4.00
$
City of Fridley ,
Tel. #571-3450
MECHANICAL 1iAR.N1 AIR:
Furnace Shell s Duct Work to 100,000 BTU $12.00 -$ /1
each add. 50,000 BTU 4.00 $
Replace=.ent of Furnace 7.00 $
Repairs 6 Alterations -up to $500.00 7.00 $
Repairs & Alterations each add. $500.00 4.00 $
STEV-1 OR HOT WATER SYSTEM:
Boiler 6 Lines up to 100,000 BTU $12.00
each addn. 50,000 BTU 4.00
Boiler only up to 100,000 BTU 7.00
each addn. 50,000 BTU 6.00
OIL BURNER- to 3 gal. per hour $10.00
each add. 3 gal. per hour 10.00
GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00
(over 199,999 BTU see Fee Schedule)
GAS FITTING FEES:
lst 3 Fixtures x $ 3.00
Additional Fixtures X $ 1.00
Gas Range to 199,000 BTU x $10.00
AIR CONDITIONING
FAX HEATING SYSTEMS See Fee Schedule
VENTILATING SYSTEMS
ALTERATIONS $ REPAIRS
State Surcharge
TOTAL FEE
ROUGH INSP. REINSPECTION FEE
Date ($10.00)
FLnAL INSP. 3, -
Date
APPROVAL FOR PERMIT / '461
$
The undersigned hereby makes application for a permit for the work hefeLn
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
eeyand correct.
Fridley, Minn. Co �C , 192�
OWNER ACZZ -
KIND OF BUILDING
USED As ^1
TO BE COMPLETED ABOUT I !>g
ESTIMATED COST a.2 00
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
$ / DESCRIPTION OF FURNACE/BURNER
S .
$ HEATING or POWER PLANTS, Steam, Hot Water, Warm Air -J No. .21
S Trade Name (?� Size No.
$ Capacity Com" Sq. Ft. EDR BTU HP
$
$ .50 Total Connected Loado&Z i.✓g Kind of Fuel /J�&i � CA 3'
$ a,5, 0eC,__
BURNER - Trade Name �a� Size No. ��tJ
Capacity Sq. Ft. EDR BTU ffq 000 HP
FINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
14
companyRAY K WELTER HEATING CO.
ICOgOV®,
Signed SwunpAmn
Tel. 'No. = - rn Ka Zl
?7-811-1,16051
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
Ilumber Fixtures
k
$3.00
$
Future Fixture Opening
x
0
$
Water
i
9
0
�+
Catch Basin
e
$5.00
e
Water Heater - to 99,000 BT(1
a
w
,r
100,000 BTU to 199,000 BTU
Heater
4Le
p
Water Softener
x
$7.00
$ .
x.1
x
$5.00
$
+a
gA
6
$5.00
U
o'y
m
lst 3 fixtures
x
'$3.00
,S
Additional Fixtures
x
$1.00
$
Gas Range to 199,000 BTU
O
$10.00
yUj
REPAIRS $ ALTERATIONS
°��
First $100.00
tin
u
a
to
bi
3
o w°
1g
$ .50
cbi w
� �
c�
�
�
o
as
lee
1st
-ang -an
e
2nd
3rd
4 th
(R) = Future Connection Opening
Connected with Sewer
V) - New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
Ilumber Fixtures
k
$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 BT(1
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:
lst 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
$
State Surcharge
$ .50
TOTAL FEE
$ 8.00
REINSPECTION FEE
($10.00)
Job Address 1591 73 Ave.
Department of Buildings
City of Fridley
Tel. #571-3450
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, Mn9-22-78 , 19
OWNER vviu
KIND OF BUILDING frame
USED AS
TO BE COMPLETED ABOUT "1-29-78
ESTIMATED COST 20.00
OLD — NEW BUILDING PERMIT NO 4PFRMX:�AO.
Company - miNNEGASC®
Signed By
Tel. No.
ROUGH INSP.
Date
FINAL INSP.
I Date
APPROVAL FOR PERMIT 966
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATS SURCHARGE
CITY OF FRIDLEY
3P36 Effective Date May 1, 1988
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
4ESIDEKTIAL ` RATE TOTAL
Furnace Shell and Duct Work,
Burner (Also replacement furnace) $ 20.00 $
Gas Piping $ 10.00 $
(piping needed with new furnace)
Gas Range $ 10.00 $
Gas Dryer $ 10.00 $
* Air Conditioning (all sizes) cZ $ 10.00 se2 D10
All Others/Repairs and Alterations
18 of Value of Appliance or Work $
COMMERCIAL/INDUSTRIAL
1% of Value of Appliance or Work $
State Surcharge $ .50
TOTAL FEE
Reinspection Fee ($15.00) $
Rough Insp.
Date
Final Insp. 4—/ '�7
Date
Approval for Permit 2Z�
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00
PLUS $.50 STATE SURCHARGE
93 _
Job Address 16"6 j /-3 rd ,,
Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
City of Fridley
Tel. #571-3450
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.
OWNER
KIND C
USED P
Fridley, Minn. 3-18 . 1921
1V DL 1.Vnr LL. H -
ESTIMATED COST n oo C?C)
OLD - NEW BUILDING PERMIT NO. PERMIT NO. ID 17062
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
Trade Name Size No.
Capacity
Total Connected Load
BURNER - Trade Name
Capacity
Sq. Ft. EDR
BTU HP
Kind of Fuel
Size No.
Sq. Ft. EDR BTU HP
nn "L� r
&
Company 1 L� _ C' �C
0
Signed By
Tel. No.
*Air Conditioners can not be placed in side yard without
written permission from adjoining neighbor.
Fill out back side for stack verification on replacement furnaces
CHIM14EY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
I.
Has been carefully examined
Yes (,)
No
2.
Is free from rust or deterioration
Yes ( )
No
3.
Has no foreign objects lodged within
Yes ( )
No
4.
Is securely supported
Yes ( )
No
5.
Meets all current Code requirements for size and
total BTU connected
Yes ( )
No
6.
Has Total heating BTU's of
All other BTU's
TOTAL
Rema rk s
Company
Signed By _
Date
NOTICE OF FIRE
TO: BUILDING INSPECTION
ASSESSING
FROM: RICHARD H. LARSON, DEPUTY FIRE CHIEF
DATE: 5/18/98
SUBJECT: FIRE DAMAGED STRUCTURE
A fire has occurred at:
1593 73`d Ave.
W/;- 796g
Date of Fire:
5/15/98 at 16:46
Building
PLUMBING
Permit No.
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd:
763-502-4977 FAX
I EFFECTIVE 1-1-2010
DATE �,-?7 b YOUR E-MAIL ADDRESS Y
SITE ADDRESS .°7 z
THIS APPLICANT IS:!TO ER ❑CONTRACTOR
PROPERTY
NAME:
OWNER/
TENANT
r
ADDRESS: On CITY STATEIP
PHONE: Cpl -
CONTRACTOR
NAME:
SUBMIT A COPY OF
®
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE, BOND AND
STATE BOND #%®y��iJf� EXP DATE
CERTIFICATE OF
ADDRESS: %y W fZ `'ter "�✓ / �Z� CITY ATE ZIPP���
INSURANCE
SY% ",eF
PHONE//d® FAX .,60*~
PERMIT TYPE
0 SINGLE FAMILY grrWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
0 NEW In REPLACEMENT
DETAILED DESCRIPTION OF WORK
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
BATH SINK/LAV _FLOOR DRAINS _ SHOWERWATER PIPING
'—WATER
_ BATHTUB _ GAS PIPING (NEED CITY LIC) SWIMMING POOL SOFTNER ($35)
_
_ CLOTHES WASHER _ KITCHEN SINK WATER CLOSET _ BACKFLOW PREY. ($15)
_
_ DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
WATER METER OTHER
}PRY2
x3k .N3�t 3 ; Q,�.,
S�" .1 e:� iaa� �� EY i�'�d �9 2j sl .� i'��`i a fa"�' '. 5p `y,5 �. #''..S N �� ✓'S3� iKY %. ��
34 f ) "th _ $� �„in'E 4C °� NM # �� �' 3'.
rS``✓1 '-�` au`4 3
If
.?. '� yY
a y ��"' � £ t 3 '�' I' �' v ✓ 4 �{i, .���� d.!Y. � � 5�� 1F� }��.��.,�� �TM4$ �'.. �£i� t'y�i�1�13 %r �� � n3 £� L
�'
.v1A 4 _,�-..F_. ... ,•S:,ei t- ,E n .,.,..ke�#,� 3 >L '&h.,'.« �a F,§'r,}+'
THIS IS AN APPLICATION F 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 appli tion f permit and work is not to start without a permit on site; that the work will be in accordance
with the approved plan in the a of hich a ire review and appro f plans./ k
�
SIGNATURE OF APPLICANT01
NT NAME �� G ATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977