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From: unknown Page: 2/2 Date: 10/3/2011 1:48:11 PM
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SUBMIT A COPY OF �xATS LICEN$� !{ � 4`�,.� I'� S Z. L�AD GERT NUN��Ii
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LOCATION OF V+rt?�IbOWB
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1, Exi�t�� �'IoorPlan
2, Pc+oposedfloarplan
3, List of structuml meanbers to 6c usCd
8p�1VBW CAI3STiLUC'rtON Il�iGLUDItZa DRCxCSy
I, 8ite Plan/Survey �ttpwit� fbe exiat[ag s[rqct�ns
and 1�r4pascd projeat
a, 'L'wo sets of conslruotiab; pla�
3. �argy Csloulatlons
I�OIi W.fPTDOW3 � PROVl13$ V-'VALUS A►ND
MANIJPACTUR:B $1TCK8R OPI WIIdI70W.
UN VALUA'Y'YQTrt, INC�.UAING T� COST OF LA�ClR ,AND
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(U3ING � 1997 U.B.0 FE� �C�pULE)
�� C(�`1 a C-� See Back Page for �'ee Sahaduio
� bS% of Building Perm�t Fee
. � ,T,,,,,_ � � � .001 times the botal job va(uation
$ 1��, A005 x Permit Va�aation MinirnUm $5.00
� !�l�t � � $SAO (StaCe Liqenaed Reaidenci$1 C4nttaatora)
S $2230 per SAC Unit (Plans to MWCC for deter�nination)
$ �i�6ft=---_ �tx$25=�
� �450 Conaetvation Plan Review
_$ k`e� Dotermined by �gineerir►g
� Agreeutait nocesssry { ) Non Necessdry ( )
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TFR9 I9 AN �r1�'f'X,ICATION FC1R A PEi2MI'� IJ�'T VALiD UN'I'IL. �OCE86BD
I hereby apply for s 6uilding pez�nnit and I acknawledge that the infqr,mat�an above is oamplete a,nd accurafie; that tha work �1 be in
aoctf'ormance witkt the ordinances and codes of tho City of Fr�dley and with the Mitmosota Constructian Codes; that I u�ci�ratand this is t►ot a
permit but only an apptir�ation for a p�rmit and work ia not to without a p�rmi� o�n site; that the wor1� wiil be in accordS»ce with tha
approved plan i� tho case att worl� whiah raqui ' rov of �a � Q y���`
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