P - 35087JUL-15-2011 08:44
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Inspectians
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763-542-4977 FAX
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TI�9 AFPLICaNf IS:
TENANT
s�MIT A CoPX OF
'YQUR STATE I.[CEI�3fi
AND CTsR1TFICA'1'� OF
iNBURANCE
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AM STANDARD WATER CONTROL �53 537 1882 P.01
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li,.�;S�DFNTIAL AFPL�CATI�N �tecei�ed �y,
CI�'Y U� �'1�IDLEX n�t� R�'Q
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STATE LICBN'$$
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SIN�Lfi FAMrt„XINER+ CO�JSTRUCTIdN
TWO FAMII."Y/N8W CQNS'iTt1,TCTtON
� HASEMENTFINir$H O ROpF T
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iYPE CIF VVORI�i G NBW HOA� C�1d�TRUGT�ON ❑ ADDITidN
�! MAINT'EN'ANG9JRSPAIR � R6MOD�T.II�TG
DE5CRY8$ WORI{ B�TG DONE;: ` 1
SIZB Ol� IMPROVLMSNT LENG1't�
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IN E'XtBTiNa OPENri�TG9 OYea ONa
OR FOR NBW QPENMGB-DSSCRIB� SI2B OF
OPENING GHANdE3 �
F�ES
AYr JQB VAI.rJA
Perrnit Fec
i'lan Rtview
Fire Surcharge
Surcharge
Licxnse S�n�charge
SAC C�tsrge
Ctub Cut fiscrow
�rasioxi Control
Park pee
Sewer Main Gharge
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TACATtpia OF WI�'bOwS
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C�RT
,,,,,NUMSER QF'W1NppWS— ,���
CIQN, ING'Y,UDIIVC THE COST O�
Tt�:1947 U.$.0 FEE S�C�YEDULE)
fd'DRAW'17LE
CI 01fIElt
1. BziseingFloorPian
2. Propored floot plen
9, Liet of muctur�l m�mbsw to be uead
FOR NLW CONSYRUC710N INCY.UDINQ DECKS„
A]�rrtalvs. � a�c a c� m�urr.
1. Site PIen/5wvoy sho�ving tha exisCing deucturoa
� propoeod �qj0ot,
2, 'I�m aets bf canatruciiom p�ena
3. Bne�gy Cs{culations
FOR VV�NDQW 3— PRO'VIDE U•VALLIL AND
MANi]FAC't'URE 3TICFCFR ON WINDO'4V',
/:�
�--!�, 11,%J Sec Back Page far Fce Sche�ule
� bS°h of Building permit Fee
� .0(?I times tho tbtal jab valuation
$ .0005 x Permit V�luati� Minimum $5,00
� $S.OQ (Stete Lic�naed Residenrisl Contractors)
� 5�230 per SAC Unit (P1ans �a MV1+'Ce for derern�ination)
� --- - .� �+�ft� Rx$25=$--
� � $450 Cansw�vvation �'lau Review
� �'ee Determined by Bngineering
� , _ !�'eement ne�ssr3' ( ) N'an Necesa:ry { )
THIS YS AN APpLdCATION FOR A FERMIT-N YALID UN7T� pROC�SB�
I hereby apply for a buildirag perrnit and I aclo�owl e thst tha i ation above is complcte arxi $ccurato; t�a�t the wark will be in
confor�pace with the ordinancea and codes d with the Minnasota ConatructioA �odes; that � underst�and thie is nat a
p�tlit �rilt 4nly Afl 8Ftp1iC8hOfi f0i $ pCiSqit StBrt WittlOUt S}fOrRllt Ot1 9itd; that tho work wi11 be in accardsnce with the
approved plan in the ea�e of sl a vsl /
SICDNA'I'URB OF APPY.ICANT . p� r.rtr"�.'.��i�e% �i% �e�.�.,.�. ...._ i`s � �' /. ,
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