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P - 43304B��iing I ections 7�3-572-3604 763-502-4977 FAX DA� � r� Za� � SITE ADDRESS _ THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: DESCI2IBE WORK BEING ROOFING NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY � YOUR E-MAl � Iv� � R ❑CONTRACTOR i v►� cc�'tK 3 ��Z� 3rSZ(- q2�i �� STATE LICENSE # EXP DATE ADDRESS: � CITY PHONE__ _ FAX _ �,SINGLE FAM[LY/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCTION ❑ BASEMENT FITIISH ❑ ROOF i7 DECK ❑ SIbING ❑ NEW HOME CONSTRUCTION D ADDITION ❑ MAINTENANCE/REPAIR ^�REMODELI p HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑ DRA[N TILE ❑ OTHER HEIGHT Permit No (� . . - -. : • i ` _�: � , r ..-�- . A' ATE ZIP FT BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl OSoffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Ptan/Survey showing the existing structwes and proposed project. O Other ❑ Fascia 2. Two sets of construction plans �'�' �'�' 3. Energy Calculations IN EXTSTING OPENINGS OYes ONo LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDdW. OPENING CHANGES & 'iYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: USING THE 1447 U.B.0 FEE SCHEDULE) 'OTAL JOB VALUATION $_� �� 0 O OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Chazge Total Due $ � $ $ $ $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $2100 per SAC Unit (Plans to MWCC for determination) _ ft+6ft= ftx$24=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( Make checks navable to: Citv of Fridlev THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances co s of t City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an applicatio or a p i�t.an wo is not to start without a permit on site; that the work will be in accordance with the approved pian in the case a11 work hj�h re uir eview and approval of pl�us!�� r SIGNANRE OF APPLICANT PRINT NAME ` [ ��" ( �� � �V � DqTE � �� � � J G � � � reC,.� ���. �.� � � �-��x.5 '� r�c. 2 .. ,��'�{��. � �u �- `/a" C� -� S�k'� c�.. �-.��. � I��,� � �,�vv �• - — s c�►���C � 1 ��- � � . —�� �� 1(�