P - 41397��� Y �r rK11JL�;Y MUV1N(ir �] DEMO [1�]'�ERMIT APPLICATION
643�. -�I�iversity Ave NE ���� ��
Fridley MN 55432 � �
(763) 572-3604 F'AX (763) 571-1287 ���� SFP 2 O �O I I
Job Address: �.,3,j�i Y�f� S'�
Legal Description:
Owner & Address: Tel. #
Contractor: � a a � S �N�- Tel. # i 7,,�"SQ�3
Address : ��i /.�� �9p,7,7� �,� �� f State License #
' DESCRIPTION OF BUILDING
HOUSE: Length �Q Width �p Height �'�7 Sq. Ft. �p� Cu. Ft.
GARAGE;Length j�c3 Width �G Height l(j Sq. Ft.�� Cu. Ft.
OTHER: Length Width Height Sq. Ft. Cu. Ft
Estimated,Cost $ ��'� Approx. Completion Date 9,3a /
CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. CALL ALL
UTILITIES FOR DISCONNECTS BEFORE WRECKING MOVING STRUCTURE.
Moving Route:
P,PPROVAL(S) REQUIRED PRIOR TO ISSUANCE:
� �
MPCA: NOTIFICATION OF INTENT TO PERFORM A DEMOLITION O YES NO
WATER AND SEWER DISCONNECT PERM BE IS D PRIDR TO O TIO
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❑ Water B ' 1 Pa ' ; Ye [ ] o Col lect, [ $ � . �%� � gnatu
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Bldg iclal Conditzons
❑
Engineering Conditions
O
Fire Marshal - Conditions
The undersigned hereby makes application for a permit to wreck/move the building described above, agreeing to do all work in strict
accordance with the City Ordinances and rulings of the Building Division, and the State Code which requires any water well on the
properry to be sealed by a State licensed water well driller, and hereby declares that all facts and representations stated in this application
are true and correct.
ALL DEMOLITON DEBRIS, INCLUDING FOUNDATION & SLAB, SHALL BE REMOVED FROM STTE,
�/�O/ll /�--� � ���-
D e Si ture
Movin Wreckin�
Principle building into Fridley ....$300.00 For each 1,000 cubic feet or fraction. ...,.$1.25
Accessory building into Fridley ...$ 42.00 For structures which would be impractical to
Through or within the City ......$ 20.00 cube, the fee shall be based on the total cost
Move a building out of City :.....$ 20.00 of wrecking at the rate of $6.(l0 for each $500.00
or fraction.
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PERl�IIT FEE: `�MINIMUM $20.00 Office Use Only: SAC-D form completed
Effective Ol /O 1 /2011