Permits - Permit# 565 - 2473 Black Lake Road - 1/1/1982Permit No.
CITY OF SPRING PARK
P.O. Box 452
4349 Warren Avenue
Spring Park, 1�1N 55384
APPLICATION FOR INSIDE PLUMBING PERMITS
OWNER
DATE
ADDRESS
2 s'�3
�?���� ZIC,
PHONE 920
PLUMBER
Xa �r�
L� e So,�,r ���i�. a 4 /eafN 9
PHONE sZ r Ff 3S
ADDRESS /S 0 / C.i 9,-- !z,> 4
LOCATION OF PROPOSED IMPROVEMENT
STREET ADDRESS �21Z22 lge-f� �� "
PLAT PARCEL
Base— 1st 2nd Base— 1st 2nd
xtures .---gent---- oor---- Floor { - ---Fixtuczr'--- ent--floor f 10.Q
ter Closets _L---I__ Floor Drains
fj _llater_Snftene�_
--------.�------i---Pispo9al—
Dishwasher
sins _ �. plater beater,
'DAriN6-iYG �IXtueEs
uh Tray I _____, I Total_ -- A—1_-I.._
FEEy/. 00
SURCHARGE
TOTAL 6 ' SD
RECEIPT NO.
The undersigned hereby represents upon all of the penalties of law,that
all statements made herein are true and that all work herein mentioned
will be done -in accordance with the Ordinances of the City of Spring Park
and the Statutes of the State of Minnesota.
L-::, 4:;�? ----
pp can
Approved
Inspector
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140. 'List!— Rev. 6-1680)
Miller -Davie Co..
6.00
OfMfPof iltltP$D, .of ___�'�z-r,*-i� -oto
__.......__. ..
County of__..... Office of
IVG ------ - - _ __. .
permit
IN CONSIDERATION OF The statements and representations made by..__ .......... _.........................................................
/,/ w t0 / i _% . c
in .... 1v.,fgL....... application therefor duly filed in this office, which application is hereby made a part hereof, PERMISSION IS HEREBY
GRANTED To said _..... _... _... _..... _................. ..................... as owner
to._._ ......... _........ ..................
,..___..________....__.....___.......___._.......... _...... a building described as follows: kind of construction
(build, erect, install, add to, alter, repair, move, wreck, as the case may be)
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 addition...Q.g.� -/2..� -g. .......
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
not cover the use of public property, such as streets; sidewalks,
not cover the following:__r__.__._._......
___._......__..._.__..._.__......._
..--................ _... ot............ ?-s, -�. ........------------- that it does
etc., for which special permits must be secured; and that it does
(Electrical work, plumbing, heating, plastering, etc., if such there be.)
for which special permits must be secured. D
Given under the hand of the.. ...` . ._...._....__ - -.of said .......... ............... _............................... and its corporate seal and
attested by its C. �.._..._ ---__ _ _this__...�� _............. of_... ---- _..........----------- -......------ ----------------------------
19
Attest
............................`' ,. __ _...... °........... _...................................