P - 44467CITY UF FitII1LEY
6431 University Ave NE
Fridley MN SS432
{763)572-3604 FAX (763}573.-1287
Job Address:�
Legal Description:
Owner & Address:�
Contractor:�
Address : � �1 o W
MUVllV[� � � li�N1v �y r�xtvlil .r�..r.r.�.l�..�..�xv�•�
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�!�`� 7�3-�z3-572
T��. #��� BB�I
DESCRIPIZON OF SUIiDIIVG
HOUSE: Length a� Width s�� Height �� Sq. Ft. ���u. Ft.
GAR.AGE : Length ��i Width `j� Height 12 �'�"Sq. Ft . j�� Cu . E't .
QTHER: Length Width Height Sq. Ft. Cu. .Ft.
Estimated Cost $� ''���� '�� � Approx. Completion Da�e �
.
CALL GOP�ER STATE O�+iE. AT 651-954-0002 FUR UTILITY IACATI03�i$ . CAL'G ALL
UTII�ITIES FOR DISCONNECTS BRL�ORB �iTRECiEING 1+�DY1`NG STRIJCTtA2E .
Moving Route:
APPROoVAL ( Si REQZJIRSD PRIGR T4 ISSiA41�TC� :
MPCA: NOTiFICATION OF INTENT'� '1'0 PSR�OI�d A ��LITIO�T �I YRS ( j�
. _ � �
I� Waterf&'�ll P�`r.d: Ye� [� or Co13.�et [
�
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ons - +
❑ "
Engineering Conditions
a Sigaa
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❑ .
E'ire Marshal Conditions
'�'he undersig�ed hereby mal�es appIicadon for a pcixnit to wrecklmove the build'mg described abnve, agreeeng to dQ alt work in striat
acc:ordancae wi[h tl� CYty U�es and rulin�gs of the Building Division, aud ihe Srate Code whieh reyuires any waeer well an the
pmperty to be sealed by a State liaensed water well driller, and hereby declares that alI faets and representatioas siateai in this application
are true anci correct.
AI.L DEMQLTfON DEBRifi INCLUDING FOUI�IDATiON & SLAB SHALL BE REMOVED FROM g1TE,
�f��`� �l L' �C._____
Da.te s g -�--
Ma�i�ag
Pxinciple building into Fridley . . . . $30(?.0(}
Accessary building into Fridley ... $ 42.00
Through ar wit�in the City ......$ 20.0�
Move a building a�tt of City . . . . . . $ ?A.00
Wreckin�
For eacb� 1,000 cubic feet or firaction.. ._..$1.25
For sttuctures which would be impractical to
cube, the fee shali be basad on ti�e totai caost
of wrecking at t�e rate of $6.00 for each $500.00
ar fraction. .
p�' �E: MINA�IUM $20.OQ 4ftice U�e Only: SAC-D for�m completed
Effective 1/Ol/2010
.. . _�
Wt/ L£� 6ti�OL Ol-OZ/64/L :a�eQ U� :a6ed .. . 860Z 98Z OZ£ �:iuoa� . ". ... ... . .. . .. . .."..