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P - 37240. �ui l d.tz�g Z�xSpeCti(i]7S 7G3�572-3604 763-Sp2-49'�7 �AX ll1T� C7���i SI'I'S ,U]L+RFSS y��� THiS APfy3„iC.1hiT]&; 'i"�.nTA1V'�' SUBMIT A C(7PY QF YCSTiS2 RTATF. i.Tf'.p.ATf£ IIND CER'I7FtCA'fH: ()t� rt�icURANCE PR CfPFR'�7�( 'IypE DESGRIBE WCJit(EAgivG From: unknown Page: 2/3 Date: 8/3I2011 1:06:57 PM , BUIi,D�lv� �S�DENTIAL �PP��+CATIl71�i c��� a� ��nLEY YQUR F-�TA.IZ. ADDRESS Q OW`dF�R A,I>bF.ESS; � STATF. t.fCFN$� U . �tvrLE FAA.IIi V2�I's�� CU�ISTRLC.TTc?N O TWD FAIvC[LY�1iEV�%CON3TRUCiIO�T 0 SASRVlF,'NT FJ1�lISH B'�QOF ❑ 1}FCK O SIDING ❑ �w xa� co�srRLr�T[pu Cr tvin�t+rr�x.a�vicernFF:nrrz E7 A�Di'�It�N LJ Ith_'MU:DEL1 Pern�it No.: ��� (� � zt���' � ; �� , Date �e�� � � �i4` . ......... S'�A'�� CF,R'f NUMB �'�" �jr'"�'`'��" tI) - QTY�� STATE,� X. `�^��' ��� %iE5 ❑ WINb�WS 0 DR41N TTf F L4t�I'E�R ' . r'L. �0. b vr \ !�f$ R OF SQU�k(ti5 _ L� '2��'{ �" �-ILtUSF � GARAGE''�'� Sr.c5Ft,1C,i'.S � t� A.T7Al:1lH�U CiAtEA(3,� Pit�]FOSFT7 S1GE; � 1?ETAGHED GARAG� PIir�POSL•D I�IGHT�r � °- C3 4'incl � CfSoffit y.Yt'4�` 9'r' .S"�.`'�E C3�o�", ❑ :1,lumimnn .. ._ ,i� (� -,47"Fna a �.��..� �t4'F"�R! � �no�.."5+� _ ❑ (}lhar w-r,r�aws Y� Et75TINCr C7P',G;�1�SNG5 O�'cs CiTie � LC�CATION OF �T'tiDOWS +_1R FOR Nl:�% DPEir7iti�'r5-Tj�SCR18E SIZE OF vPE�rT.vG l':FIn1�tiiY,J t� _. .-- k'��5 ["OTAL JdB �A,LI Permit �'ec Plsil .Ktw7ew Fire Surcliar�e ' SuxcttAr�;e GiCGns� Surc��t�c SA� Ch�r�e Cwh Cut f•::ec:r�w l:msion Control PArk Fee °w�vCr 1Kain Ch�,iig4 F3ASRi NT FMpDE�,�7G 1��� 1, Fxisting Flaot Plan Z. Proposcd' floor plan 3. Lint o.f st�u�iwsl mcmbcr� m be uscd F4it rrEa� cox3'�iUCTiOtt nvGr.LmTNG DE dd2D��I0N5. & P�RCI�ES ct�$n�i• 1 Site Plan/Sarvey shbwing thc cxict+ny �rd propoRCd rr�jeet, %• 'i"wo acta of cos�Avttim! ptana 3. Entr.gy C;alcuisti�rns FL1R W2N77(7W5 � f'f€OVII?E U VALVE AND MANUFACTLRF. 8'f'!(^.KF.R �N w1Nix�a. rn.mssER o,r• wlt�mows f70N, �TCiUDING T�iE CdST O� �ABOR T�.�;g�Zyr !3.[: i+EE S�'HEDIJLE) � __,,,, � See Bac$ Pag� for Fee Sc�r,ccl.ule • -- -- — $ _' 65d/n af EUiId'u�g Pe,rnlit Fee �' �.QOI tim�s the total job valuatir�n $ ' � .ODOS x permrt VRli�at;nn �,;n,� �S,pp _ $ � �S.O(� �5tat� Liceased Residentiai Coni�actors) � ~ 52230 �Cr S!},C ijtijt (PIa�B t0 MW�� �OT dCtrrmi��#1pn) $ ft r G ft=—.. f�, x$ZS= $ $ $45f� Gonscrva�tion �Ian Review � Fee j�etetmined hy �;ngineesing �� , ,.... ` Agr�ement neccssarp ( ) Non Necese�ry ( ) P 1 Ig+'1 i nf� �.r-'-- -.. _ .. . . . _.. . — -- • 7'E3�S IS :1N APPI.2CA"RC1T�i Fi1R A vERj��T-1tiC�T V,�.� t�iTIL PROCfS3LD I T h:erCby app1� fo�` a building pe�it and I ac�tiowledge tht�t tho infarma$on 8bove ig com�+lete artd accutate; tbat the warlc will b'e in canfarmauce with the orc��tuYCes and codes of the City pf Fridley arni with the Min.r�sota Constructi4n Godes; ti�at I Lu�ders�td t�� i5 r�at a per.ttlit but o�e�v �n �pp]i�yuoII f�t a pexmit and wr�rk i.t mnt tn st�rl: vvithaut � permi# vzz oitc; tt5nt tl,c w�crrl. will Le i�u Haa-vniancc wlitf ti1C appr�n eci plan in tha case of kt work +h� �ure51'�'vic�� and appraval of p ( ��r� STCNA'tURFQF:�FPLIC.4��T +L �- PRY�ITNs1Mf•;,' '2i't ��.Cl:� PJATE � �t ,�PtiROt�AL INSP�c"rOR SIG 'A7uRE �---.,� ,�i1sF'r}liiSL'^.t�ii]'.T�j ,�w'�F'P'IQi1�"•f'�?�lfi,".Ali:ffT:C�:;l�1��2aa•rtr•rr:sr»:nr,F.:�:�...»-..w._....,..:....,,,.�,.....�� ..._. ___ _