Permits - Permit# 682 - 2425 Black Lake Road - 5/28/2021Va
SPRING PAM, 1 INNESOTA Wer��t
GBNSRAL INFORMATION
1. Yon away sprig lot pfaeAiap V4,10its by ma/f of Is petSoa at the city o614ee6. (O
!. 0441e4 In 4prt4s4t4os6 ail sr.o)att to the posta0@ and ha441140 lists •horn haler. ►eAsit C44d6 will ee stet by tetY+n
M/l the Same J4V the appffedtion aS tdee[ved.
1. ►(QUITS ARE ver VALID 4110111 VOU RECEIVE A PERMIT CARD.
I. WRK MUYt NOT •EOIv U4111 Toil 1ERMIT :AID Is POSTER ev rod )06 SITE.
!. ptve6440 retail• may ha iss.[@d Q f[:teic.l ptr[.hrti o% to hoeeJeattlotcupdaes who isttsd to aatuaffy 0440"• cite'+
own wriR to thdil heat. , /.
S. *when any now coastiuc tion of ttmodelrs0 is [nvotved. a 6eea14te Auitdin0 041sit must be Melded.
1. A11 We% MOST R@ Will IN ACCOROAM YITN JIM RUICONO COP( REQNIR(MEVTS.
S. Att .et•tr assat be 446plated ho(ota it 14 aovaaad. Cott J'!•'IST 'Y
INSTRUCTIONS
templet@ see 49e06 on this application. 6ep644e the paa■tt let. Saps and date the aeet# jitit:i6.*_•:.
110CMPIETE A/POCATIONS rlll MOT It PROCESSED.
1708 3I713 ADDRESS d;JXES
Ova - •
-F-mel' :tips[ _ residential ` Corrarclal Other: Work to be perfortsad byr•
Owner's Name 23!&j=x ME, dhel-I �C�t u S�fc�� Telephone 'No�,�[
Mailing Address
Contractor's -Name
Mailing Address
City License No.
Telephone No"�4_
Master Plumber's State License No.,
ra.vtsaitvu r att-rut� aa,at.u�aaEs
(Show nutebor of elntures of Saab type oe each 1l6esr1%._
r
IrIMPA TYPE: oSmT. lot Floor_
2nd Tor_ Other ►looF� ►I U Y /ftlT.
Zed flour ! Otnn: !
me her
maehtu0 _ _ - _
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_ wotra,e�liater• _ ..__ -
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S!°S.hien 41nM
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melee: ►lstuces: ,.........r...
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OlRPuILDaum&
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Palms
EEBSIT JEEE C�1C�ILATION :''
FIXTURE
the EIItalmun1 peaEa.tZ bet~
_IZE
compute T M 6.ixtu tea
Z. State Surcharge Sd( t..
agate 6-fd4M0 Cod@ Division so%chatta to .: .
3. Postage and Handling
on all •oated-aa asof.eat.raa. add tha.►oa.tapt 4441 halidl,�pera.
S
1 TOTAL PERMIT -FEE
.ad r['w,es I•! I'�ini' :
Y' •..
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OD. SD
The redtaaiRntd 6e1te6y dpplata to the Ciro o! tile■• /ea iSauaaee o/ a NUMBING ►IRM1T,'a,14e@a to A off IF00 in .t+
06 t++t frty on+: the +r;.+.lat.e.+• rr the Nanara.•fe State Earaldanp Code, and ream ..
aeeoeJaaet rtth the r+draaaeta
elf [taltA@ala aeJr va tnr[ eppl.rat.,vr a•r tr.�ttett, f+u: +++J lr++erl.