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P - 46804Fram: HomeSure Page: 5/5 Date: 11/17/2011 2:22:43 PM €w r- r i- r� i�+:�r� nuuic�ui•a ica :r �rv�! a�c-�r�+ru r�fa Baildin� 13C1ILDYIVG rcrn,it No.; �d �-(a3 " Zx�spect'rons ��IDEN'��A,� AF�'LICA"�'IC�►N xe�ci�ed �y. .� �63-5?2-3&04 � ` "� ��3-so2-a���� F�ax C��'� UF FI�YDL�Y �+� �.��� �� EFr•�cTiv� i-t ��tr 5fI'E ADDRESS _1;, T191S A(�PLICANT I$; TCNANT SUBMIT A COf�Y QF YOUR STATE LICENSE pND CERTfF}GATE 0'F lN3U�CL t�[tdPC1tTY TYPE OF' D�SfiR]F3E WiDRK YCfUR E-MAIL A171?RESS 17 OWNCR `ij�ONTRACTOtt : �t�1,s* rtirYtl, '�i" �''l��l S'I'A'fL•' LtCL"N5E 1f FINGL� FAMILY/NCW COhlSTRUCTI+ TWO ('AMILY/NEW CUNSTRUCTION d dASCMCNT FINi:iF[ I� ftQ�F [7`C}�Ck � STt7IyG p NEW 1•IOME CONSTRUCTION Q MAINTENA�ICE/REPAIR rr NUMLiER QF SQUARE$ fARACES f+ROPOSED SIZG: PROPQSEL7 E•IEIGFIT; ---.. .. �;tnrrr.. I�l Vi�iyl t7 Alun�inpm � Othcr wir�nnw� ZN CXlSTING OPGy1NG5 OYe� ONo OR fOR NCW OPEIr'#NG'S•D@SCRIBL� i1�E �F �P�NIN�r CfiANG�S bt ARF, JO� VA�U f'ian Rcvicw Firc Surehargc SurCharsc Licensc Sur¢hargc SAC Char�;r Curb Cut �scrow Erusion Control Park Fc� Scwcr M;sin Ghargc ❑ ADb1T{UN 0' R�MQl7EL[NG 0 FIOU5E ONLY o E �ous� � cnr�ac,c C]A7'7'AC1•I�a �ARAGE �1 D�TA�'1•IFf� GARAGB C]5011t1 ❑ Triro 'd Fnauiu i.00A7'14N OF WINDOW:C CkRT NUMBF:R �_ClTY_� CI DftAIN TILL" '❑ UTI-I�R NUMBEIt C?F WINI]nW$ \L,J ON VALUATIUN,INCLUDINC TI�E COST QF J„ _(US1NC T1IE 1197 U.S.0 FEE SCH�DUL,E) r�,�j_zir �,pC,ysTnTe�;hl,7rr�$ 13ACEMENT REMODE,J jN�c e {;Mir� 1, Gxiating f%lavr 1'Inn 3 (+YUpn�cti 1]ocr �al�ll 3. Liy� vPatructural trnmisen tu tx u;u.�J F(?R NF.W Cf�NSTfIUC'T10N MC'LUDII�C; L�GCKS, ADDITIUNS. Fe PORC[1G�,,^,� 1f�Mw 1, Siic PlAiV5urvc�y sltuwiifg nc� cxisting xtructunr n�t�l pt��sascd projec1. 2 Two mm� oJ'eoirKtructinn nlan.r 3. Lner},y Cvlcuf:tti0n;� Fc7R WINDOWS - PROVlDE U-VALlJG A�D 1vtANUFAC.TUR� STICKE[1 �N WlNDi�W. �'1"E�ttA45: � i S 3- L� Sco Back Pase for Fco Scl�eduic � C�5'%� ol'Builr�ing l'c�mil F'c� � .UQ] ti�ncy thc tvlai job vaivativn � .00�5 x Pcr�Y�i� Valuation Minimutn �S,QO S SS.i10 (St.tte Li�cnxcd R�sidcntial Contraelorr) $ 52230 per SAC Unit (Pl€�ns tu MWCC for dcicr�nination) $ rt •f• G Ii = n x 525= S S a450 Con�crvntion Plnn Rcvicw $ Fvc DctcrnZincd by �nginccring 5 A�.recment ncc�ssary () Npn 1�lccc�iary () � 0 �6< Z Mak�e cltfickas puvable ta: City af FridlcY AttaCh Sti TH151S AN APPLIGAT1t7N fOIt A rEfZMt'P-�IU7 VALlD UNTt1, PRCaC'ES��� I hcr�by �►pply far a builciin�; perini� and I acknowledgc tl�at ttic i�ifornt�tiUn �bov� i.r' L'Wn}SICiC and aCCUC:iIC; thnt thc wark wi11 hc in conformanec wi�h tlic �rclinsncc� and codcs �!'thc City of Fridlcy und wi�h U�c Minnctiu�a Gonstruction Codcs; th4Gt 1 undcrst�n� �tis is n�� u pern�il bu� only an appiication I'ar a�cnnit ancl work is nat �o �l�rt wi{hout a permit oi1 sitc; thttt thc wurk will bc in aCCUrt�sncC with the apprnvcd plan in tl�c casc of a wsrkwhic�li�1'_juires rcvicw uncl :�p�iroval oC plsn�, . 9 �f�� SIGNATURL Of APPLICA 'f �, _._ _�/'�` � PRINT NAMG� ��C1,,_4�Q�-" DATG /r •��nnvR■ �xicnarmnnc�t. .�m�mc