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P - 42135Building In�pe�tions 763-5'72-3604 ?63-5��-4977 FAX BUILDING RESITlENT�AL APPLICA,.TION CITY UF FRID►LEY Perrnit No.: Received Date Rec'ct'�" " DATE .,,�-�„ .% �'`°� J f __ > YUUR $-MAIL ADDRESS ��'�,,�e' rs �,° �'"i*r?.:� i'O"�''�e.' i�i<�s.'� r�"'�~�33 S�'fE ADDRESS T • `� � � � � f �� _ THTS AAPLICgNT F5: L7 OVJNER �CUiVTRAGTOR TENANT SIJAMTT A COPY Q� - _ T, . .. �.. . ,�� _ Yt7[iR ST.ATE LtCE1V"SE STATE LICE1fT�E #�,:. L"�f <�* ° t"7� �' ,�a �LEAD CERT NUMBEk AI�t�7 CER"TIFIC,A'iE t�F �nllRES,s: �� °,��.'c3 %/G� �'c✓'� i�� C[TY �.��(��,�'�' STATE ZiP�'� �' IN�URANCE pHnt�r�r ,� 1 � -- "�'�"� - �`�-°a� t ,�,, �. FINI�H ■❑ L7 I?RAII�i Tii.�s O QTHBR ------ DES�RLSE VI�t3RK BSINC3 DONE: �ZE tJ�P' IMP�UYB�ENT I�F.1�ICi'TF� WiDTH iiEiCrHT $�'1' � Hi31TS� (}NT.,Y BASEI�'"NT �r� at3�; � t��r; rru��t c�� s�ua�s /�. o xqu�� d� Ga�� ."�--�-- ! . �isci�g FI� Fian GI ATTACHED GARAGE 2. Prapnsed fluar glam PRQP("3�EU S]ZE: 0 C)ET�tG7iED CiARAGE 3. List ofstnschu�) rnombcrs ro ba used PROF�p�ED HEFGFIT: � C7 v`m� Cl Alu�rtin�m Cl Uther �� IAx E�I�'�'It3C3 DI'Ei�N'G5 Cl"Yes faATo OR Ff�t NEW UPEI�ITl�tGS-D�.SCR1H8 ST�E OF OPENTNQr GfiAh1C3ES & Plan �.wievti� F'ire 5urcharge Surch�e Li�c�� Sureltarge S1�4C Ck�ge C:urb Cut F..s�rcyw Ere►sian �r�ntrc�t Pa�rk Fee �e�w�r Main Charge ��Q�� S�qNNE 0 Tnm Ca"Fasa� Lf�Cp.ZTflZ�T OF WIt�UOWS (v�IN� �r$� i��'i U.�.� �E� s►��v�..E� F41t NEW C()1�3STixiICTIt�N iN�LUbiNC3 bI3CK5, ��.�.�.��.�� i. Si&s Pt�niSurva}+ showin$ the �aeisfing slrucWres anct pr�p�sed p�je��. 2. Two sots of c�un plaatis 3, Ener,gy Cslculaticrns FOR Wiiy[70�5 — PRUVI��E U VALLiE ANU 11�1A14(LJFACTURE STIGi{HR ON �II�tDOW. �s$ro �� ' a UUi times tP�c ti�tal,job valuatian 1�'��'L .Ot105 x F"�r�vit Val�,atit�n 11�tiuirnt�rn �S.OU —�!� $5.00 (5tate Li�ensed Resid�n�a1 Contractors} �2230 per SAC Unit (Pl�ns to MWCC for determia�ativn) f�+6ft= tix$2S=$ �45i1 �onservation �'l�n �eview �ee T7eter�►ined by En�ineering A�reement necess�y ( ) Non Necessary ( ) T"f3IS I5 AN AI"FLTCATION 1 t�Tt A p�RMIT-NQT VALd1� U[�TIL PItOCESSEU I herelsy ap�sly fc�r a buildu�g pe�mit and I ac�Cnc�wiedge that the iufor�aiion abave is c�omplete a�ad acc�uate; th�t the wa�rk will be m c+�fi�rur�nce with tt�� ordina�tices and cc�des of t�e City c�f Fridley and with the Minnes�ta Cunstruction Codes; tftati 1 ctntierstand t;�is is �aat a permit i�ut oNy an app�ieaticra f�r a pern�it and v�ark is nat t4 st�rt without a perrn'tt on site; th�t tt�e vvork wiil be in� accordance wit}� the approved ptaai in ch� case �f all work which rc u' s eview a�d �pprowal of plans. Sif�TiATURE OF APPL[CANT PRFI*I'f NAM� ""i��'� �� h.� UATE ��'f �� A'PDithS1.4T T�d:ClslJl°IYtA fit�3#7d . . . .. �.°° a �— . �