P - 42132Building
Inspections
763-572-3604
763-502-4977 FAX
BUILDING
C O MME RC IAL/IND U S TRIAL
CITY OF FRIDLEY
EFFECTIVE I-1-201I
DATE %U �'�j �� YOUR E-MAIL ADDRESS
SITE ADDRESS �2 .j p ��'d. Sz� yE' �'� �- c�l L e�, ��
TENANT_
PROPERTY OWNER
Suite No.
Permit No.: ��� � ����.'�.�
Received By:�
Date Rec'd: �(�
NAME: /%G' Le Y1 ,� � c1 O S
ADDRESS: ���0 �X'Ce L�� c�r �L V o� CITYS�, LOc�iS1�
PHONE: �%S Z " �� � " '� � Z �
ARCHITECT I NAME:
CONTRACTOR
* NOTE: CITY
LICENSE REQUIRED
COMMERCIAL,
INDUSTRIAL AND
MULTI FAMILY
PROPERTY TYPE
PERMIT TYPE
PLEASE SUBMIT
ADDRESS:
NAME
r 2� � e
P .�'sy2G
CITY STATE ZIP
ADDR�SS:6 �6D ��rc�����Dr BLvd, CITY.��. �o�;.s �s�rA�E��z�P5sy2�
PHONE� �S_Z — �3a ''�� Z FAX
❑ TOWNHOUSE COMMERCIAL/INDUSTRIAL ❑ INSTITUTIONAL
❑ MULTI-FAMILY
❑ ADDITION O NEW CONSTRUCTION ❑ OTHER
❑ REMODEL ❑ ROOF ❑ SWIMMING POOL
I. 4 SET SETS OF DRAWINGS 5. CONTRACTORS OR LICENSE 8. 1 SET-DIGITAL OR ELECTRONIC
2. SURVEY/SITE PLAN LICENSE APPLICATION PLAN
3. LANDSCAPE PLANS 6. SPECIAL INSPECTION SCHEDULE
4. ENERGY CALCS 7. PERFORMANCE BOND AMOUNT $
BUILDING TO BE USED AS: OFFICE sF WHS sF OTHER sF
TOTAL SIZE: STORIES FIRE PROTECTION (YM) AC(YM)
DETAILED DESCRIPTION OF WORK �b LGtG e r✓t ��. W�� v� c� � t.v's
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and 1 acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plans.�
SIGNATURE OF APPLICANT : vQ
APPROVAL INSPECTOR SIGNATURE:
ALL FEES RE SED ON VALUATION
�
i i
Sq. ft. x$ l Cost/sq. ft. = Valuation $
Sq. ft. x$ Cost/sq. ft. = Valuation $
Sq. ft. x$ Cosdsq. ft. = Valuation $
TOTAL JOB VALUATION: $ � O ' USE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
SAC Charge
Erosion Control
Park Fee
Special Assessments
Total Due
$ �U 5, as
$
� ,
$
$
$
$
$
TE: /d . o S � iI
DATE��
OCCUPANCY TYPE
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$2230 per SAC Unit(Plans to MWCC for determination)
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement.necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach St�ulations