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P - 43704Building , Inspections 763-57z-3604 763-502-4977 FAX BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY VE I-1-201! Permit No.: Received By: Date Rec' ' DATE Y'OIJR E-MAIL ADDFtESS ,J��•Sci-/cJrrlrr�f=-r��r'})S,d'.�v rr� G � SITE ADDRESS �r %/ p � �`� �-v c ,1.�!'' I TH[S APPLICANT tS: ,�'OWt�iER QC013TRACTOR PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OE INSURANCE PROPERTY TYPE NAME: � bS�D/� �'%a �C�NUl��i�.� � ADDRESS: �")/ � � T� �V� �[//� C1TY /`�lll �i�� STATE��ZIP;y�� PHONE: �ip3 " S 7/ " S�p �i7 NAME: STATE UCENSE # LEAD CERT NUMBER ADDRESS: CITY_ PHONE FAX � SINGLE FAMILY/NEW CONSTRUCTION S[ZE� � TWO FAMILYMEW CONSTRUCTION STORfES PERMIT TYPE 0 �D�Ttotv ❑ GattaG� 0 BASEMENT F[NISH ❑ ROOF P'�DECK ❑ StDING ❑ SWIMMI TYFE OF WORK: �"NEW HOME CONSTRUCTION ❑ ADD[TION ❑ MAINTENANCEIREPAIR ❑ REMODELMG ❑ DRA[N TILE � OTHER STATE ZIP DESCRIBE WORK BERVG DONE: �u/ ID1 L'�! �erJ��G i�,�C� � i/ �1 SIZE OF (MFROVEMENT LENGT}i� /� � W1DTH "y�6 HEIGHT •. a(� SQ FT dS ROOFING NUMBER OF SQUARES _ GARACES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ V inyl � Aluminum ❑ Other WI:�IDOWS IN EXISTING OPENMGS ❑Yes ONo OR FOR NEW OFENINGS-DESCRIBE StZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit 0 Trim � Fascia LQCATION OF WINDOWS NUMBER OF WINDOWS BASENiENT REMODELiNG SUBMIT: L Existing Fioor Plan 2. Proposed floor pian 3. Lis[ of structural members to be used FOR NEW CONSTRUCTION 1NCl.UDiNG DECKS, ADDITIONS. & PORCHES SUBMIT: t. Site Plan/Survey showing the existing structures and proposed project. 2. Two seu of construction plans 3. Energy Catculations FOR WINDOWS — PROVIDE U-VAI.UE AND MANUFACTURE STICKER ON WINdOW. ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIAL,S: (USING HE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ ��] �� OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ _1�,3-2 $ � . $ $ $ $ $ $ $ $ —'�_� .�— l 101�) See Back Page for Fee Schedule 65% of Bui�ding Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $5.00 $5.00 (State Licensed Residential Contractors) $2230 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$25=$ $450 Coaservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks aavable to: Citv of Fridlev Attach lations THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNT[L PROCESSED I hereby apply for a buiiding permit and 1 acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of firidley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit an work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case af all wh'ch re ' es review and approval of pl�. 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