P - 35795Building BUILDING p�rmit rTa.:�Iz! �� (p
Inspections RESIDEl�TIAL APPLICATIUN Received By;
76�-s�2-��04 CITY OF FRIDLEY ��i��'
'763-502-4977 FAX £��cTTVE,-,_�o„
DA'FE �" �rc�—"'� 1 �� YOUR E-;4tAR,ADDRESS 1—� e-t�ry�� .� ru ��-C-F XS , Co r�-�
srrE Ann�ss �,'��_�" �,`�`�''' S� a 'C�.s�-'—
TFIIS APPLICAN'f IS: O OWt3ER �ONTRACTQR
PROPERTY OWNERI NAME:���-9 �c�x� Ser f
TENANT ADDRESS: �L� �' S�� �i"• � CITY_��� STATE��ZIP �S�'J''�joZ..
PHONE:�I�-' �U� S`T�,_`
COi�iTRACTOIt AiAME: P�� �jceJ�.'._�v},jy��S CDt'l 1[± n�
SUBNIIT A COPY OF S'fATE LiCENSE #o2.Z7i'{ LQ Lc' �-I �') LEAD CERT lvt: MBER �' _' � S�� SS- � CJ ' C709 % D
YOUR STATE i.I�ENSE
AND CERTIFICATE OF aDDRESS:c '�2L` lo �-• C?�-T�" St • CITY,�u/Nist% l UL°. STAT�ZIP��
IN$�N� PHONE �, FAX - D S'
PRO�ERTY TYPE I�StNCrLE FANID.YiNEW CONSTRttCTION SIZE�S� •
O TWD FAMILXRVEW CONSTRUCTION STORIE
PERMIT TYPE ADDi1'[�N ❑ GARAGFISH£D � WINDOWS
O SASEMENT FINiSH (,�ROOF ❑ DRAIN T1LE
O DECIC C4 SIBSNG 17 OTHER
fl SWIIvIAd1NG PoOL
TYPE QF WORK: ❑ NEW HOME C4N5fRUC7`fON ❑ ADDITtON
C�MA[NTENANC�/REPAIR ❑ REMODELTNG
DESCR�IBE WORK Bfi1NCi DONE: lr� -(� �4 �
SIZE OF IIt�'ROVEMENT LENGTH WIDTH HE1GIiT S FT
Nt7� F SQUARES ,� �' � t)U5 & GAItAGE �ASEMEN7' REMODELING SISBMIT:
i. FaistingFioorPian
y� ❑ ATfACHED GARAGE 2. Proposed tioos pSsA
PROPQSID SIZE: � DETACHED GARAGE 3. List of swctural members to be uscd
PROPUSED HEICrHT:
FOR NEW CQNSTRUCTION INCLUD{NG DECKS,
0 V�'uryl DSoffrt ���T��[;t & poRCHE5 SUBMIT:
!. Site Pian/Sunrey ahowsng t!►e ex�ating struct►ues
Cl Atuminum ❑ Trim and FroPosed P%lect-
0 Utlxr ❑ Fascia 2. Teuo seLc of ca�tion pt�u
WS 3.
�' Ene[gy Caiailations
INEX[3TINGOPF.NINGS �Yes i3No LOCATIONOFWINDOWS FORWtNDOW3—PROVIDHUVALUEAND
(}R FQR NEW OPENtNGS-DE5CWBE SIZE OF MANtIFACTURE STICKER. ON WINUOW.
OPENINGCHAI3G£S &
TYPE OF WIl9DOW T4 BE INSTALLED NUMBER OF WWDUWS
AL,L FEES ARE BASED ON VAL.IJATION, INCLUDING TIiE COST UF LA,BOR AND MAT'ERIALS:
Plan Review
Fere Surcharge
Surcha�ge
License Surchazge
SAC Charge
Cucb Cut Escrow
Brosipn Gontrol
Park Fee
Sewec Main Charge
(USING TiIE 1997 t1.B.0 FEE SCHEDULE)
S �(� l�.L�; See Back Page for Fee Scheduia
$ _,i b5°lo of Building Permit �'ee
S , .U01 times the total job valuation
� .ODUS x Permit Valuation Minimum $S.flU
� $5.00 (State Licensed Resideniiat Gont�actors)
$ $223U per SAC Unit (Pis�ss to MWCC for detemiination)
$ ft+6ft= RxS25=$
$ $45Q Consavation Plan Rev'sew
$ Fee Determined by Engineering
$ Ageetnent necessa�y ( } Non Necessary { )
THIS iS AN APPLICATION FQR A PERMIT NOT VAI.ID LTNTIL PROCESSED
I herel�y appty far a building Pennit and I acknowiedge that the information above is camplete and accurate; tfiat the work will be in
confamance with the ordinances and cades of the City af Fridiey and with the Minnesota Consiruction Codes; that I uuderstand ihis is not a
permit but only an appticabio� for a permit and work is not to stsrt without a pe�mit on site; that the work wi1l be in accordance with the
approved plan in ffie case c�f �which requ' es iew and approval of ptans. /-�
SI(3NATURE OF APFLtCANCi�r�� ��/ PRIAIT WAri4E ��cri� f� � K�(9 ��J DATE %' ��' I�
. ............ .......s........__ �.,.._..
ALEASE NO"i'F:�.�+`..FPAi2ATF. PFRMiTS ARE REQLiT1tED F�R PLUMBiNG, ELEC'�'RICA,L AND