P - 39361�li Y vr rxi�L�Y MUV1NCi �] DEMO [] PERMIT APPLICATION
6431 University Ave NE .�y-��
Fridley MN 55432 �� f'� � � `
(763)5?2-3604 FAX (763)571-1287
Job Address : 5 � �� 6r'�. $'�-�����, � �
Legal Description:
Owner & Address :���/ yf� �j�-- �'��� Tel # 6/_�,i--�/„L^. J��—
Contractor: /�/�,,�,a„� WL�- Tel . #�(�3 -3c� -�ssrr,
Address: %a ` �a.�t1��Si�v Avt 1�i�-- State License # �Q�/Cir�j„ �_ �
DESCRIPTION OF BUILDING
HOUSE: Length Width Height Sq. Ft. Cu. Ft.
GARAGE:Length o1-a-� Width I(, Height � Sq. Ft. �_ S'"� Cu. Ft.
OTHER: Length Width Height Sq. Ft. Cu. Ft.
Estimated Cost $ Approx. Completion Date `��(��/�
CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. CALL ALL
UTILITIES FOR DISCONNECTS BEFORE WRECKING MOVING STRUCTURE.
Moving Route:
APPROVAL(S) REQUIRED PRIOR TO ISSUANCE:
MPCA: NOTIFICATION OF INTENT TO PERFORM A DEMOLITION O YES O NO
WATER AND SEWER DISCONNECT PERMITS MUST BE ISSUED PRIOR TO DEMOLITION.
❑ Water Bil1 Paid: Yes[ ] or Collect[$ ]Signature
❑
Bldg Official Conditions
❑
Engineering Conditions
❑
Fire Marshal Conditions
The undersigned hereby makes application for a permit to wreck/move the building described above, agreeing to do a11 work in strict
accordance with the City Ordinances and rulings of the Building Division, and the State Code which requires any water well on the
property to be sealed by a State licensed water well driller, and hereby declazes that all facts and representations stated in this appli�eation
are true and correct. �
ALL DEMOLITON DEBRIS, INCLUDING FOiJNDATION & SLAB, SHALL BE REMOVED FROM SITE
Date
Si
Movin�
Principle building into Fridley . . . . $300.00
Accessory building into Fridley ...$ 42.00
Through ar within the City ......$ 20.00
Move a building out of City ......$ 20.00
Wreckin�
For each 1,000 cubic feet or fraction.. ....$1.25
For structures which would be impractical to
cube, the fee shall be based on the total cost
of wrecking at the rate of $6.00 for each $500.00
or fraction.
PERMIT FEE: n,� MINIMUM $20.00 Office Use Only: SAC-D form completed
Effective O1 /O112011