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From: 7635742044 Page: 2/3 Date: 6/9l2011 10:53:35 AM
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FI1S J�I.i'I�LICANT 1S; C10WN�Ft
U�' ���E'Y
No,
Rece�ved By;
�7ate ��
_ ..... _ ..�
YOLfR E-1�tACL A,p��ESS
I�fCONTRACTOR
'ROPERTY OWJV��/ N�: O �.t
TENANT
ADDRESS: CfTY STATE,,,,,�,Zjp„�,,,,,,_
Pf�IONE: ��`itD� � S�Z[ " S� Z GI
SCT�Mt�' A. COPY OF STAi� 1�106N$� fl�...�.0!-4y 9 bi � --- -- EXP DATE ti�..
YOUR S'Z'A'iE ).�C�NSE ADDRE5S: i(�O 4�w CfTY 1
WI'�"Fi APPLICA7'tON � -y� ��+����-N STATEM,,,,,�ip„�' �(Z$t
__ I+�ONE[�( '�� !.�,� tVJ� FAY��f�'7� � r 7A11!!
❑ BAS�M�.�tJ'x' �'�SH Ci ROdF
C3 CiBC�L i7 51DFN(3
'WORK:
�ESCRIBL� WORK BEING
L?E OF IMPROVEMFNT
uMBER QF SQUAR.ES .`. _ ---- .- -.
��
tOPOSED SL�Bt
�aras�a r�rr�Nr: --
D HOU&E & GA,R,ACrE
❑ AZ7ACI-IED QAR.AC3E
� I)CTACHED �q,�p,,��
aWG
Viny! C]SofTt
Aluminum ' O Trim
4thar � ❑ FaaciB
►��G OPEN1Nt75 �Y+� CENo LACATION OF WiNbp NS
R FOR hi&W Qp�,N�f•T(;g,�7}��gE SIZE OF �V ilFb1 , l4i'� �[i �
?ENIIJG CNANGES � ?' � —+_ $0�/
fFE (]F W�Lk1W TA t1X' ti.re�ra r � rn .. - - -. . _ .. .___ _ _... . .. a .r
JOB
=�nonit Fee
.�n Rcview
xa Surc}�arga
u�charge
,censc Surchargc
�►C Charge
�rb Cat Escrow
•osion Coz�trol
u�k E��
:wcr Main Charge
ON VA,�UA,TION,, FNCiUb�iV'G '�'Zx� CpgT
. . (USING 'Y'Y�� � �97 U.B�C F� SCH�DtT;
$
� �
�
o D�a.n� rr�.�
(� O'i7�IER
�.Cr {x Qy-a
�� t�;��iri"a'. Sq Ft
�..�% '�T R RRAPJD 7 fl �P f rpj�.flT.
I , Existiing �loor �'Isn
�. Proposad floar plan
3, Liat of strucn�ra� men,bers to bc uscd
FQR NEW CONSTRUCT'ION MCLUD[hIG bECKS,
aRA S •
1. Sitc PlanlSurvcy showing t� axisting strucWres
t►Md prdpb9td project,
2, Two sets o�' eonsuuction plams
3. Encrgy Csleulatiens
See �gck k'age far F�c Schedulo
65% o��uildia� Permit Fcc �.
.041 ti�es the total job vAluation
.0005 x �erarraat Valuation ivxinimum �.50
$5.OQ (5tate �.icensed Residantial Concractors)
$] 675 per S.A,C UniC (l'ians to MWCC fo�r determinatiott)
ft�6ft=�ftx�21=$
$450 Conservation Plan �teview
Fee bCter�naned Uy l�nginaering
A�raerne�t t�ecessary ( ) Non Ncccssary ( )
Ma1ce c�ecks payable to; Citv of Fridlev ,�r��..
'['kC15 CS AA1 AF'PLICATION TOR A PERMiT�NpT Vq.1,ID UP1T(,L FROCESSED
I�ereby apply �or a building �crrnit and t acknowledge tlaat ktae iraformation abovc is complete a�d accuratc; thgt tha work will bo in
��£o��Ce wi� the ordinancos ac►d codcs of the City of Fridley and with thc Minncsota Canstruction Godes; that I understand this is not �
r�n�t but a�aly an applicati for a permit at�d work i:, not to start w;tlaout a pernrait; that the work wiil be in AcCOrdance with Che npprovcd
�n in the ease ofa�! work c� requ' s rev�ew �nd approval o£pians,
3NATURE OF APPLICANT 1/P�._.-� ��PR� NAWIF �G�'t' �.(�C�"'1, ��A�� �
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