P - 42112�u�l.din.g
Inspections
763-572-36�4
763.-502�4977 FA.X
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'I'�AS APPLICANT iS:
PR4PERTY aR+1�TTsR/
TTNANT
SUBMIT A COPY' OF
YOUR BTAZ'� LICEtiBE
AND CERTl�'lCtl'1'E OF
INSLTRANCE
From: unknown Page: 2/2 Date: 6/21/2011 9:21:52 AM
BU�LDING
RESIUENTIAL AP'PLICAT�Ol�
CITY UF F���i�
YOUR E-MAD� ADDRESS
0 OwNER
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O TWO FAMII.YlNEW CONSTRiJC17pN
❑ ABdI1I0N Gg$AG
O BASfiA�1J7' FR�IISH t8�li�ObF
❑ D�CIC 0 51DING
TX�� 4I+' WORK: O NSR%HOM� c':qNg'CltUCATON O ADbTIION
�AINTENANCElREPAIIt O RHM 1
A�SC�BE WOR1C 9EII3G DONE: ,
SFZE OF IR�"KOVBMFNT i.,Y.1Vl*1H WII.
ROOFING � O H US�E O�II,Y
N�I4�&K OF SQUARE3,� �USL dt GARAGE
SrASB�rE� , �17ACYi�D GARAGH
�LOPtlS�D SIZ�: _ 0 DExA,Qi�D GARAGE
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TN TsXLS1YNG QPENIIQGS O'Yas OlYo
oR r•oa r+�w op�rm,res nssc�s srzs oF
OPETTING C�iANGES .�
►e
P�aa Rev�ew
�'�ire Surchar�c
SwcL�yr
Licenae Surcktarge
sAC Ck�nrge
Curb Cut E�ccrow
Erosion Co�tk[oI
Park Fee
5cwcr Main Charge
ARF. RAST4A AN V
oso�c
O Ttim
o i�aw�a
C1TY'kS'�
Y.EAD C�Rt l'�f.fMBER
�� 7G3��
SIZE—��•—
STORLES
O WlNDqw3
4 DRAIN TII,E
n rn'�t
Lc�CA'[7C1N OP WINDOW3
NC�EK OF WWDOW:i �
Ai,i7ATTAN, iNK'I,[FXaIPjG THE COST UF
S�N'G THE 1997 U,B.0 �E $CHEDULE)
Pemut N
Received By:
��l'LBEMODfiLIN(} SUBMIT:
1 FxintingFirv�rPtan
2. Pcapoatd Aoor plsa
3. Laat of ftn�Atrnl membas to bc uacd
�Olt l�w C1�1�31RU�:iIUN II�LUDTrvc: Ur�
,annmot.�. A P��t��S st.nBt�arr:
1. Sise PIafUSurwy showing fhc oxnte�g
aztd yropaed vroicd
x. 'r•.o:sts of cansaaa�on plans
3. Energy Calwlatiotre
FOR wlM7�W3 -PYtaVIDE U VALUE AND
I�lAN1.1FACTiJ1CL 97PCKFtR QN WA,TpQW,
t#NA MAT�RIAL5s
� �-s. 7�5 8cc �ack Pa�c for Pcc 9cliedulc
� ' C5% of Buildiag Peemit �ee
� .001 time� tb;e tot.�t job valuation
$ .00US x PtTmii ValuatipzJ. Minmtutin ,�5. W
$5.00 (State Lice� ftes'u3entisl Cantractozs)
$ �223t7 per SAC tJnit (Plans to MWCC for determination)
3 ft+6fi��_. ftx��5=S
$ $450 Conservation k'�ax� R�eview
� Pet Detcimined by F.ngineering
� Agraement ruxcssa�7' () Non Necessary f)
$ �— Meke cbtecks oavabte to: Citv of Fridiev Attac
�S xS AN APFLICATION t'Olt A P�RMTT-NOT Vy� UNITL PiiOCF..S9EA
I heretry apply fox a building permit and T acknow��ge that tho information a'bove �s eomplcie and acciaate; tbai tl�e wark will in
confarmance with the ordi�zces and cod�s of the City of Frid�oy mnd with thc Minn�ota Con,stt'�ction Codcs; that I understat'�d this is ot a
pamxt but only an application for a genmit atld work is not to start withaut a permit �n site; lhat the work w�ill be in a ordance wi the
appx'oved plan in thc csse of rk ires review And a waI of 1 (� tt_
SIGNATURE OF AP��.ICA.NT � � �tN['NAIufF.P �i�t1 F �1C0`tJ� ne�ru ���< «
11