P - 39915From: unknown Page: 2/2 Date: 8/23/2011 2:30:45 PM
Buildin� ��iT���'i�TG pe�t rto.: 2.� i C`�. l
InspcctiQns �ESI�ENTIAL AI"FLICAT�UN zteceiV�d,By: �`�� "
7��-s7z-��o4 CITY �F FRIDLEY z��.t�i��B; A��_2 2�1
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DATE � �J { � YOUR �MJ�II. ADDRE33
ST't� ADDIiESS �
7"Ei�S A;PPt,TCAN"I' IS:
'T'�NANI'
SUBMI7 A COPY OF
YOEJ�L 5'Ft'17E LIGi�tSE
AND CE�'�FICATE OF
INS[7RANC�
PIZU,Y.k:At'1'Y '1'YYLr
I7 O�NER
STATE L[r_ENSE a,
nnn�ss: �9DR
�'SLNGE.� FAMILYlNEW
f] TWO FAMILYlNEW CC
❑ snsr-.�rrr rir�ce�r �oaF
❑ 1?�CTG L� 3�1]ING
c:��t�r �s-�, a.�y
LEAD CEl2T ��
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FAX _I_�� `��
5I7F
STOR7F�5
n wrr�mows
o nxnar x�
❑ P'IT�ER
"1'Y.P� Pk' RTORK: ❑ NEW FIOME CUNSFRUCT[Ot�I O AnTliiTf)N
�"'1CdAiNfElvAlvC.��PnlR � R�MOA�NG
D�sCRi�E wORiC BETlv� noN�r: bA�.�
sr, � vr• nvv�xOVY.nn�N � LENGTH WIDTH
��+� F 5QUARES � ��ffOLISE dc GRRaGE
PROPf3SFT� SIZH: ' ❑ D�'A,CHED GARAG&
PRQPOSFfi �IGHT;��
fl�'�
❑ Atumiimm
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Ar[N,�,�I _QW'S
IN�.YTSTINGOPF.N1NCi5 �Yw ONo
�R F48. N�w�a�m.tG�-�S3c�t�t& SS7,fi O�
�3FE�;G GHANGES �
Per.r.rtit Fce
Plan ki,�wiew
Firc Surchax�e
Surchar/�c
License Surci�ge
SAC Ck�arge
Curb Cut Escrow
FroSion Co�mn1
Park Fee
Sewer Main Charge
flso,�t
a �hm,
❑ x�a�
LOCATI�2v OF W�1ppWS •
vA.l�UA� i'iOPi. iI�TCLTlI)i11TG TRF. [�nS'�' UF
(i'fSING T�[� X997 i7.S.0 FEE SC�ELI�ULE)
rin
BASEMENT lt`Ftwc��P.r txc. ctmurrr-
t. F„�Cia4id�floori'lan
2, Pf+o�oeed tIoor pl�n
3. • Liac of atrnatara2 mr.eth�re tn be uecd
�'OR NE41 CONSTitUGi'�iDN INCZUI7�NG D��S,
I Sitsl'liu/Sorvey�fosvLtgthe'<arietingxctuet�t�
�a �;�a p,,,�.�.
Z, Two ads o�oo�traction pluu
3. Emecgy CalcnTatio¢is
FOR WiNDCyWS —PYtOVLLI� U VAZ,t3E AND
M�WZJFRCxL1RE3ITldCLKUN W1N1X3W.
A.1YD
Pagc for �cc ',a'phcciule
- -
$ ' ,y_ 65% of $uildi�g Permit Fe.c
$ .� ; .00I times the tatal job valuetian
� _ c' .00tn x Permit valuauon Minunum �S.Od
� ' $S.dO (5tate Licensed Residentiai Coritractors)
$ $223b per SAC U�xit (Plans io MWGC �oi dcYermmation)
$ #i�+ 6 ft = _____�—� ft x $25= $__.
� $450 �onse�vation Pia� kZGwiew
$ . . . Fe�e Dete�n�d by 'F'xtgirteerinE
� A,grcement �ecessa�Y ( i Non NecessstY ( )
THZS [s AN wPFr-t�A7iON Fvn A k�lth�iT NOT VALID i.fl3�`l7, pR0(�3SED
I k�ereby app�y for a buiidi�g pemlit and I ac�owiedge that the i.z�'oimation above is enu�plete and accu�ate; t'hat the wark wi� be im
confvrmaace with the o�rdinances and codes of the City of Fridley and wifh the Iviisvo�esota Constzuction Cod�es: tbat I undexstan� tt�is fs n�n s
peranit but c.aily aa applicatio� ;Cor a pesmit a�d vvbrk is not td sta�t �+vithput a permit on azte; that the wqXk will be i�ll �otd�E,ttCe y�rltt� �i¢
appraved p�an ia the ca� of���work ' c �es s+eview aud approve� of
SfGNA7'[1I� bF APPI.ICANT ' ' FRIN!'NAME���Y1 � �I}ATF � l%
Ai+PROV Ai tta�.r_.TnR SI A , _