P - 48042Building
Inspections
763-572-3604
763-502-4977 FAX
BUILDING
COMMERCIAL/INDUSTRIAL
CITY OF FRIDLEY
EFFECTIVE 1-I-20ll
,
Permit No.: � �
Received By::
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C� v
DATE � � ���d: � � � YOUR E-MAIL ADDRESS +� L,.� �-�� �(� � �- C��--�c �hS {- , N���
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SITE ADDRESS `J�Z-`� l �i !'� i✓�- J`c_ N<< :
TENANT Suite No.
PROPERTY OWNER I NAME:
� C� i��e --� 'i� , -Z
ADDRESS: � G� � ��L �.� � 5� � CITY �S �-� STATE�`n��IP > 5 y Z �
PHONE: `�� � 2 � � S - C> � � �l
ARCHITECT NAME:
CONTRACTOR
* NOTE: CITY
LICENSE REQUIRED
COMMERCIAL,
INDUSTRIAL AND
MULTI FAMILY
PROPERTY TYPE
PERMIT TYPE
PLEASE SUBMIT:
ADDRESS:
CITY STATE ZIP
NAME: � c� C ��� C�C^� S�-rvC��V �
ADDRESS: � S 2'Z�. C� �-(C L�.�� CITY �2��� STATE�.�' ZIP �'���
PHONE: iP ( � � 2 Z - (� � `2� C� FAX CQ � �_ � 2'Z- ^ Q � s� �
❑ TOWNHOUSE
❑ MULTI-FAMILY
❑ ADDITION
❑ REMODEL
1. 4 SET SETS OF DRA�
2. SURVEY/SITE PLAN
3. LANDSCAPE PLANS
4. ENERGY CALCS
❑ COMMERCIAL/INDUSTRIAL
❑ NEW CONSTRUCTION
INSTITUTIONAL
❑ OTHER
❑ SWIMMING POOL
5. CONTRACTORS OR LICENSE 8. 1 SET-DIGITAL OR ELECTRONtC
LICENSE APPLICATION PLAN
6. SPECIAL INSPECTION SCHEDULE
7. PERFORMANCE BOND AMOUNT $
BUILDING TO BE USED AS: OFFICE sF WHS sF OTHER sF
TOTAL SIZE: STORIES FTRE PRO/TECTION (Y/N) AC(Y/N)
DETAILED DESCRIPTION OF WORK �Z��a�•���L � � !c �-L, �:,,�..�9 w PS -f- ��e-'<�-�-e � -�-- �
THIS IS AN APPLICATION FOR A PERMIT-NOT VAL1D UNTIL PROCESSED
I hereby apply for a building permit and I 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 per it 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 w ch requir review and approval of plans.
SiGNATURE OF APPLICANT : PRINT NAME: �!� D'�y � LLI �� �� DAT�:
APPROVAL INSPECTOR SIGNATURE: DATE:
Sq. ft.
Sq. ft.
Sq, ft.
COTAL JOB VALUATION: $
'ermit Fee
'lan Review
; ire Surcharge
Surcharge
iAC Charge
�rosion Control
'ark Fee
ipecial Assessments
Cotal Due
ALL FEES ARE BASED ON VALUATION
x$ Cost/sq. ft. = Valuation $�� C� 6��'�'
x $ Cost/sq. ft. = Valuation $
x $ Cost/sq. ft. = Valuation $
USE OCCUPANCY
$ �,rC��,�
$
$ '�
�
$ y '
$ ..
$
$
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 navable to: Citv of Fridlev Attach
TYPE
lations