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�spections
53-572-3604
�TE ���Y�I U
i E ADDRESS � �
[IS APPLICANT IS:
E:�t ERTY OWNER/
TENANT
CONTR.ACTOR
SUBMIT A COPY OF
QI,JR STATE LICENSE
;TJITH APPLICATION
PROFERTY TYP�
PERMIT TYPE
z YPE OF WORK:
• ♦
BUILDIiVG
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
. ,. ,,
YOUR E-MAIL ADDRESS
❑ OWNER YdCONTRACTOR
�nD�ss: ! o o v G 1 h'' � V i N�
PxorrE:_ 7 �.3 � 5_? y• !1 ��'
Pella Windows & Doors
N�'— 15300- 25th Avenue N.- Suite 100
STATE LIC Pij�1T10Ut�1, MN 55447
anDx�ss: �63/ 745-1400
PxorrE _ License# 20165884
'B S7NGLE
❑TWOFA�
❑ B.4,.4EMENT FINISfI
❑ DECK
�J
�CRIBE WORK BEING DONE:
-E OF IMPRflVEMENT
'•,�IBER OF SQUARES
::�4GES
>POSED SIZE:
:!POSED HEIGHT:
ING
"inyt
_luminum
lier
�DOWS
'�QSTING OPENINGS C91'es �No
�OR NEW OP£NINGS-DESCRIBE SIZE OF
�NING CHANGES & � �
� OF WR�IDOW TO BE INSTALLED
❑ ROOF
❑ SIDING
❑ SWIMAZINCi POOL
.4IIZ ❑ REMODELING
LENGTH _
❑ HOUSE OI�ILY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHBD GARAGE
QSoffct
❑ Trim
❑ Fascia
Permit No.: ' '
Received By:
Dafe Rec�'i��i� . t
CITY �F�I q �./1/ STATE_ZIP �SY 3 �
�, �c%t M ��dr/' 0�11
�is,� 3+tS- GoY�
CITY STATE_ZIP
�
iACAT'IOI� � WINDQWS
l r L�u,�,�y !'oul�
NUMBER OF
❑ DRA.W TILE
`9 01T�R Pli�i a Q�ae ,l'
HEIGHT
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor p2an
3. List of structural membecs to be used
Ft.
FOR NEW CONSIRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBNIIT:
1. Site Pian/Survey showing tl�e existing shvctures
and proposed project
2. Two sets of construc6on plans
3. Energy Ca.lculations
ALL FEES ARE SASED ON VALUATION, INCLUDING THE COST OF LA.BOR AND MATERIALS:
([TSING T$E 1997 U.B.0 FEE SCHEDULE)
. TOTAL JOB VALUATION $__ 3 �/% OCCUPANCY TYPE
nit Fee
i Review
:harge
Surcharge
nse Surcharge
: Charge
� Cut Escrow
ion Control
: Fee
°r Main Charge
:I nne
$ g �, a 5 See Back Page for Fee 5chedule
$ 65% of Building Permit Fee
$ /, �! 1 (.0005) times the total job valuation — Minimum $.50
$ 3. (. '� .001 x Permit Valuarion (1/10%)
$ S. U� $5.00 (Staxe Licensed Residential Contractors)
$ $1450 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= $x$20=$
$ $450 Canservation Plan Review
$ Fee Determined by Engineering �
$ Agreement necessary ( ) Non Necessary ( )
$ O�_ (, Make checks navable to: Citv of Fridlev Attac
THIS IS AN APPLICATION FOR A PERMTI'-NOT VALID UNTIL PROCESSED
�eby apply for a building permit and I aclaiowledge that the information above is complete and accurate; that the work wiil be in
_�rmance with the ordinanees and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
:it but onIy an application for a permit an work is not to start without a permit; that the work will be in accordance with the approved
in the case of all work which requ' es ev' w d approval of plans.
ATURE OF APPLICAN PRINT NAME ( , / - ! � � � / n �� DpTE � l � ` ` ( O
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