Permits - Permit# 563 - 2473 Black Lake Road - 1/1/1982Permit No.
CITY OF SPRING PARK
P.O. Box 452
4349 Warren Avenue
Spring Park, MN 55384
APPLICATION FOR INSIDE PLUMBING PERMITS
DATE
OWNER /t
PHONE Z
ADDRESS S�� d 33
PLUMBER
ADDRESS
LOCATION OF PROPOSED IMPROVEMENT
STREET ADDRESS`�'�
PLAT 1�,Zo f5 PARCEL
PHONE I �a fS
Base—
1st 2nd
Closets
9ter 1
Floor Drains
,
I
ath.Tub�--—.-----
---- - -----—UisposaL--
Dishwasher
si
ter
I G I ISpecial 4lastas
Total
FEE 7
SURCHARGE S0
TOTAL.
RECEIPT NO.
Base— 1st 2nd
m
The undersigned hereby represents upon all of the penalties of law,that
all statements made hance withrue and that he Ordinanceslofwork the City of mentioned
will be done -in accordance
of Spring Park
and the Statutes of the State of Minnesota.
41�. o '09/47 '14� 1'��
can
Approved
Inspector
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Form No. 259—(Rev. 6-10-80)
Miller -Davie Co.,
-7S
Otate of M31tursata,
County of..................Y�...... {��]../). /qV
r f L
no._— 56-j___.__._._
-_- _zzlkl7;_ _...of— .---.�... .... -.........
-
Office of __ ._._ _......... _...
hermJF
it
IN CONSIDERATION OF The statements and representations made by.— .......... __......................... ............._
`'............ _._.......... - ——............. _. _ __..__...._..... -- --- - ..._ -- - ---........................... ---••--
in.. .... s Zi'?.)...... application therefor duly filed in this office, which application is hereby made a part hereof, PERMISSION IS HEREBY
_...-...-•------------.......-•-------._--...---------------•----------------- --as owner
GRANTED To said ................. <r ,,d:.f� - ..............- _.__ .
to ......................, „................................................................................ - ...... -.a building described as follows: kind of construction
( build, erect, instail, add to, alter, repair, move, wreck, as the case may be)
............................. _u .G_....... ...........................-.....::.........:-::.:1. _................. ...............
front or width in feet........................................................: side or length in feet ........................................... ........... ; height in feet ...................................................... ;
number of stories ........... ............... ...............: contents .................................................................. cubic feet; -- ................. ......................... ..square feet, upon that
tract of land described as follows: Lot ....... ..................................... Block ................................................... _...... ; plat or additiot�'...?.,S—../. '5-A-------
--------•...................................................................Y.:7. Ve ...°i---....%��- ...- ...- .:.�... �.-..: ..- �' .............. .�.1..�-.
1. �!. -
which tract is of the size and area specified in said application.
This permit is granted upon the express conditions that said owner and ham_ contractors, agents, workers and employees, shall
comply in all respects with the ordinances of the .......................... �... -...... ... f'!............ _..... _-.... that it does
not cover the use of publicproperty,such as streets sidewalks "alleys etc., for which special �its must be secured; and that it does
r � Y�Pe
not cover the following:
(Electrical work, plumbing, heating, plastering, etc., if such there be.)
for which special permits must be secured.
Given under the hand
of ................... .... ..of said _. _ _.end its corporate seal and
attested by its ................. c...-----.................... _...... of—_
Attest:
-----•......................_......._._....._...................................._.._......-- ---.__....---.....-- _.- _ ... _ -- ----------........... --_ _ ... -
... _...... .._c_