P - 42745Y_ � V` `� _ Y y. � v. ,. From: 3202348919 Page: 1/1 Date: 12/2/2010 3:08:10 PM
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Building
Inspectiar�s
7d3-S72-3604
763-502-4�77 F�X
DATB I I � .'� �! " �
SITB ADDRESS ��
Tf�I6 AFPLICANT [3:
p'Rt)PEIi.TY QWNER/
TEr�a�vT
CONTRACTOR
SU$IVTIT A CDPY QF
YOUR STATE I,ICENSE
ANL7 CERTIF[CATE OF
1NSURAN��
pRQPERTY TY�'�
PERMTT TYP�
BiTILLI►YNG
��sTn��rT��� �,�p�,ic��rro�
CITY OF FRIDL�Y
Yp'UR B-MAIL ADDRFSS
Ct OWN'�Ii �CON',
NAME; .�.
ADDR]SSS;. � I��� s�
PHOIVE;_��r.s��.r �"
NAME:_( a��.t fr +�'j
$TATE LICENSB �! � D �`
PHONE - - �
Q SINGL& fiA.MII.YAYEW C4NSTRUCT14r
0 TWO FAI4IILY/NEW CONSTRUCTIQN
❑ $ASENIBNT FIIVISC�[ IJ�KOOF
❑ D$G[� 'r� BEDING
-- - ---
TYPE OF WO$K: ❑ NEW HC?Ivt$ C�NSTRUCTION [j ppp�p�
AlNTENATVCE,IREpAfR ❑ EZEMODEL[NG
1]�,gCRIBE WORIG BEfNG DQN$; .L 1^ ' G G
S1Z4 OF IMPROVEMENT LENGTH Wip77-�
� � H4USF ONLY
NUMSER OF SQUAhFS _. �"f "J 0 HOiJ5E & GARAGE
� ❑ A'ITACHED GAkAG�
PEZQPOSED SIZE� ❑ P$TACHED QARAGE
PROPdSGD HEICii7: ��
��
❑ V inYl
❑ Aluminum
❑ O:h-r
?�Y -T)bwS
IN EXIS7ING pPBNtN45 ❑Yas ONo
OR FOR NEW OpHNIN(,Zg.DESC(t(BE SIZB dN
OPE�IINQ CHANG&S �tr
TYPE OF WINDOW 70 BB tivsTar,r_F�
❑ Soffit
� Trim
C7 Faacin
LOCATION bF W)NDOWy
OF
Permit No.:
; - - -, :
i,� ,.� . �
ATE�LIP��
EXF DATE
cITY�,�,�y�aN BTATE�'i�LIP�+�
❑ DRAIN T[�.g
l7 OTHER
FT
1 Existing Flaor Plar�
2 Proposed flopr plan
3, List oistruewral me,nber� to be used
FQR NHW CQNSTRUCTIDN INCC.UDfNG DECIC9,
ADD]TIOh1'S. & PORCHES�}UBMIT:
1. Sitc P1an(Survay sho�ving the exisiing atruclures
and p�oposed projact,
2, T�,ro a■t� of consteuotion plsna
3. &nergy Calculatioris
POR WIIVDOWS - PRQYIISE [:-VALUE AND
MANUFACT[]RE S7ICKBR QIJ WTNDOR',
ALL F�E$ ARE BAS�D ON VALiJATION, INCLUD�NG THE C�6T OF LA$OR APID 1VYATERIAL9:
{i��rxr� �rxrF 'i997 U,B,C FEE SG'ii�pULE)
TQ'�'qX, JOH VAL[' ' """""' `
���
Pcrmit Fep
Plan R,eview
Fire Surqharge
Surchar$e
Lieense $urGha�'ge
SAC Cherge
Curb Gut Escrow
�rosion Cantrni
Park Fee
Sewer Main Chargo
See aack Page for Fee Schedule �
65% of Building Pqrmit Pee
,041 times the totsl jvb vaivatian
.pOpS x Permit Veluation lV,(inimum SS.00
�5.D0 (Stata Lioensed Rasidential Contraatora)
$2100 per 5AC Unit (Pl�na to MWCC for determin�tion)
ft+��}� ftx$Z4=$
$�50 Corisbtwation Plan Review
Fae Determined by Enginoering
Agreement necessary ( ) Non Necessary ( )
7HI$ I$ AN APPLICATIC7rii FOR A PERMIT.NOT vALID UNTTL Pxac&bSBn
I hereby apply for a buitding periziit and T acknowJcdge that the information above is complete and aocurate; that the work wilt be in
oonformance witla thq ordinanoes and codes of the City of Fridloy and with the Minnesata Canstruction Codes; that I understand this is not a
permit but only sn applicarion for a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved pian in the caso of c w' � uir�s re 'ew snd approval oEpians.
SIGNATURE OF APPLICA � PRINT NAME�,M I I�� �!�Yl.�ir. DATE I�;'� lC�
AFPROVAL IN3PECfOR SIQ '
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