P - 42734� uilding
� nspeciions
i63-572-3604
DATE / /? �
3iTEADDRESS �
,HIS APPLICANT IS:
�
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
Permit No.:
Received By: °
Date�'1�: �u� $
YOUR E-MAI �D�SS '�o �; s� c<c�'� � o�,.c s, c o M
5 ffl� � /V' _
❑ OWNER 15�ONTRACTOR
;?Rt�t ERTY OWNER/ N,�: �/ �' S Q,� .� Q� V
TENA1vT ,�Dx�ss: � 8 V 4 3�� 5� /(/ � ciTY
PHONE: �I � 3� S% i" pZ / 7�
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
N,,,ME: THD At- Home Services, Inc.
srATE r.ic 2690 Cumberland Pkwy, Ste 300
.anDxESS Cumberland Office Park
PHONE Atlanta, GA 30339-3913
� sINGLE Lic# 20268257 Ph. 763/542-8826
❑ TWO FA �
P�RMIT TYPE QADDITION
❑ BASEMENT FiNISH
❑ DECK
TYPE OF WORK:
❑ ROOF
❑ SIDING
❑ SWIMMING POOL
D ADDITION
AIR ❑ REMODELING
�SCRIBE WORK BEING DONE: Y W/ n d�'O
IZE OF IMPROVEMENT
OOFING --
�JMBER OF SQUARES
?ARAGES
ZOPOSED SIZE:
::OPOSED HEIGHT:
LENGTH
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
ATE_ZIP S� 4 3 7
3Y5- C.oy'7
CITY
:E
ORIES
'9 WINDOWS
❑ DRAiN TILE
❑ OTHER
s �n .r x�.s � n�
TIDTH HEIGHT
ATE ZIP,
a D/ ii ! n i�/ s
BASENI�"NT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of shvctural members to be used
Ft.
'LUING FOR NEW CONSTRUCTION INCLUDING DECKS,
7 Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT:
�' :�.�uminum !7 Trim L Site Plan/Survey showing the existing structures
� Other ❑ Fascia and proposed project.
'IIv�DOWS 2. Two sets of constructiot� plans
1 EXISTING OPENIIJGS �Yes �No IACATION OF�� OWS 3. Energy Calculations
'': FOR NEW OP£NINGS-DESCRIBE SIZE OF I(�� ft /SM ,�t �/`0 0 6h f � a U n �%Y
"_�NING CHANGES & y
`:'PE OF WINDOW TO BE INSTALLED SI i G(� t!' S NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
TOTAL JOS VALUATION $ G�� 1`�99 G.B.0 FEE OCICUPANCY TYPE
'ermit Fee
'ian Review
urcharge
'ire Surcharge
icense Surcharge
AC Charge
:urb Cut Escrow
.osion Control
ark Fee
�wer Main Charge
'otal Due
$ •7%
� !. S Y
$ s.ou
$
$
$
$
$
$ •3
See Back Page for Fee Schedule
65% of Building Permit Fee
(.0005) times the total job valuation — Minimum $.50
.001 x Permit Valuation (1/10%)
$5.00 (State Licensed Res'idential Contractors)
$ I450 per SAC Unit (Pians to MWCC for determination)
ft+6ft= ftx$20=$
$450 Conservation Plan Review
Pee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks navable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID LTNTIL PROCESSED
hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that the work will be in
�nformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
°rmit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
ian in the case of all work which requirss rev2e d approval o€plans. �
sNATURE OF APPLICANT ' v PRINT NAME (/� S C�� Ii� DATE � � �