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P - 48053E3uilding II1Sj��C�10115 763-572-3604 7G3-_502-4977 FAX From: unknown Page: 1/1 Date: 6/3f2011 11:20:43 AM �� � , i� -�"?- � t.�� BUILDING RESIDENI'IAL APPLICATI�N CITY �F FRIDLEY �:rrr:r rive i-i-�oi i [):1.I � l _ / ---_—_. �? / ii l Ot�R L AfAll �DI)IZI Sti ��..( (..��.JG r'�. �L. _ - _ .._ siTa: �nnKisS J; � l J ,.(,r �� � �:. , _ ,—. 4 «-_.. . ��L�. ��_... ! _ . .. .. . __. _. v� ,�f111S :11'1'Lli'AN'I' Iti. � ❑ OV✓i�!h;R �4�C'{)N'TIL\('TOR. Pet-n�it No.: ��%� � �(1�J .. . lZeeeived I3y:___ __ � �'��;.�i�_Lv_..�b �.���1 �,; � � i�t r� ��_i_=r. r�,�.:. ' j;�� �.. (- --- rCt()f'FRTY f)'�'�'NER/ N.atitr c � , _. ' --.. TEN:INT _ / �r ',. � '-1 �4� :? _. . -- AL)1)RL tiS:—Lr � .i, � �� ./V !�— �� '� �'��_l I I 1' � %C (ai_i `C. .tf .... _ .__ S 1 \ I Is�/�rit 71P��_ 5^ r�.,:::� l _ � /. ,r Ytlf)NI'—l��._.� ,1',"� � _�� t �(...y / conTR;�c;roR ;- �, � � / �. , � � -... � NAMI r!{i!✓ .- +.- 1��� �t �•, ' if�.:f/`L[i.'.�( G/:�:_ >. ?�`+`/ li/ Sl,:�a ii,�C SUB�ifT A C'<)f Y OF . �..,•. _ � t� � ^, tiTA"1 h, LICt'VSL } .1 � ! � � ( .,' f7 � 1•'UUR ST.'1TL UC C:NSI' C', t%,.,� . 1 1.w C 1:It 1' VU�7131 k�- J ! ��' >/� !� �`/I z- ANU Ci:RT!] IC � fi:: ()P A�>uRt:SS:I' s._1�-�t � j�. S`� ���..._._ . _.. _ �'�t vy�if�—�,c �..._ _Sl 1" h//�.f'ili ��tr �r ._ _ . INSURaNC,f�. ` _ �; � _ G'(: c.�' i"�� ._ .� rix�rvc •.c� - r'..� .._�,�G. ; <— 1'ROPI?R"CY TY'f'F: ❑ smc;[.i: i nm��i_v�rv► �u c'cm;rrti �criorv tiiii_ --- --. C7l'R'O FA�tIL1'i[�i;ti1- CONS'fRUCII<3N S"1(7RtL•5 PERNiIT T'I��r: T��rr oH� ��'ORK: L=113:\tiLihiliNT t�INISi( p IIIiCK ❑ N}i�ti� IfO�v1L•'CONS"fRUC'-IlON ❑ MAIN"1'ENANC'i:i%Itl{PA112 __.._ .......... . . . � Ci:1RA(.il!;SI11:{:l � �41N[)U�VS ❑ K(3C3P ❑ I)RAIN'1'ILL O S1DIN(i ❑ O'TI1tiN ❑ ti14YMAi1N(i YOOL. O :11.)U i'Il0 V (Cef KLh1(iDF:I..IN(i C)L•:ti('KIF2E 1�'ORK 13L'INC., DONL'': �� i'�I.f�..__�_ ��' . L.::. {_ Pi_ %. _ f� Li:': S!%!i Of' IA-1PR0�'Hiti]F:N"f LLN(iTll ROOFINC CJ IiOliSl( (.)NLY NIIMBIiIZ OF SQU:�RL'S _�"l _�/ �fIOUSL; fi,G,1RAGL G:U2AGH�ti ❑ A (.1'ACl lhil) (.iAR:1CiL- f'KOF'OSEU SlL.ti' ❑ UF"I'AC'I1EU GAlZAGL Pt2OPOtiE�L7IIL'101IT:-- _ tilUlV(; u v�» yi CJ :iluminum ❑ Othcr LI Su �i n � 'I'rim ❑ Paicia /1�i-.1L'., � ., 3 j ��� ���� �=-. _ _. �VIU 1'I I I1GI(il l"f SU !.[ H.ASI?MEN'1 RLiA-I(ll)GL.iN(.i Sl;I1M1'C: I. Ci.cisting I�Icwr Plan 2. Proposcd Iloor plan 3. Li3� uf structur:d mamhcn Io bc uscd I�C)R NL-:1W CUNS'TRUC`t't(7N INC'I..UI>ING Dli('I�S. ;\L)L)fClON�, f� PORC'll6ti SUE3�_111;. 1. Sitc PIa���Survcy sho�vin� nc� �xistin�� uru� n�r,; .: and prc�poscd pr�jcct. � 2. 'I\vo scl. ol'conshuctina pl:m. �VINDO\YS 3. Encr�y ('alculaUans IN 1:\Iti7'ING t)PliN1N(.iS U1"os ❑Ni� LO(':1'1lON OF' 1��W1)014'S FOIL WINDO\�ti - PKOVIUIi lJ-VALUI.i AND OR FOR N1:11• C1PLiNIN(�ti-DGtiC'N{Rf? tiVl-:!)F __ V1ANUk�AC'l'URL S'1'tf'KLCRI)N �1'IND(?\4'- _. _ OPL'NlNi.i CII:�NGL•S & 1'1'PL• QF \1'1N1:)01V'IO f3L•' WtiTAI..1.h:D N(!tii(3l:ROk 15'IN170N'ti _ _-- _..__ .-----_.....,_. _.. _.... .._.._�..._�---- -. .....___.. nI.L �'EES aRC. BA,SED UN V:�LUA"[70N, INCLtJD1NG TtiF. C:OST OF 1..,1ROR AND i1�1ATE[21,�LS: (lIS(NC T}tl�. 1997 U.B.0 FGE SC'MIEDULI�:) TOTAI.. JOI3 V�V,U:1"f10N $%t'` .'��I�%• C%Ci UCCUPANC'Y TY'PE Prnnit T�cc �G'��' � ;� >��" �� _ Scc Ciack Pagc for Fc� Schedidc ...._...,,., Plan Rcview 5 6�`Y, ol 13uilding. Pennit Fec; Eire Surcl�ar��e J '��j, �.001 timcs thc tc>tal.job �-afualion Surehar�?,e ti .0005 x Permit �'aluat.ion h4inimtml $�,00 License Surchar��c ;ti a�;-.�lr 'ti�.Q(} {St�ite Licensed Resici�ntial Contractors) SAC Charge S ti22 �0 per SAC Uni1 (Plsns to M�VCC ti>r del�nnination) C'w•U Cut E�cru�u S lt -i- 6 tt - __ ti x S"'�3 :: � _.._. . _. ._. Erc�sion Con[rol S S45Q Ca»Servatiim i'lan Review Park Fee S Pee Dete�mined by I:nginecring Sc:wer Maiit C'h;irge }; Ajrcemenl necessary O t`1on Necessary O Total Uue $ % 1 �, 14r�ke checks pa,yabte to: C'ity o1' Fridley Attach Slinulutit►ns l'1115 IS :1N APPI_ICA'1'I(:1N PO[t A Pl:I:MI'1"-NO'I' V 1L.11> UNl'll.. PNOt'IiSSlin I hereh�� apply for 8 bL11ICI1R�� ��ennii and [ acknowlcd�c. thal tlre inli�m�atic>n aberve is comE�leie anc) accuratc; that the �vork �vill b�• in conti�rmance ���ith thc ordinances and codes of�the C'ity ol' Pridlcy and ���ith the hlinnesota Constr�.iclion C�ales; lhat I understand this iti nnt ;, pcnnit but anly an applicauot a rermit ;ind ti�ork is not lo �t,ir[ �tiilhout a permit on site: tlial !he wi�rk will bz in accordance �vith ih�� a��rro���� plan in thE c n� of all �� � i}ch ry xur4 �c,vi��� and appruvat u! pl �ns, Sf<:��IATIJRE C)h' APPI I( 1N 1� �,.L�6t �( ij.�.! �� _..._._. __.. ._PIZIN'1' N:�NI ) i J- T i�' i j1�- �l I�ATk., �� J II APPKOV 1L (NSPf:C' I'OR SICiNATI•'3RFi _-'----- -- ----- ........ .. __.. _. . 1'C..T:ASE NOTE: SEPARA7'F. PERMTT'S ,4RE RE:QUiRF.C) FOR Pi.,UMf3ING, ELEC'TRICAL AND Mf;CFiAMCAL. ��'C?RK.