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P - 48598Buildin� Inspections 763-572-3604 763-Sd2-497'7 FA� na� �rr�� STTE At]D�ESS �i "('T�ts AI�LiCr�.IVT fS: PRO��R'�'Y OW TTNAN'Y' SUBMIT A CdPY' OF �'i7U1Z S�TAI'E LY�:ENSE ANI,] CF,F2Tf�'iCq'J'E p� TNSU�R,ANG� From: unknown Page: 2/2 Date: 3/7/2012 9:04:14 AM �"C.S'trQC'� � i�� .� 1 . - ....�...�,... �ITILDII�G � RESIDE�TIAL AP��C,A.T�0�1 CIT'Y OF FRID��Y xOUZt F Mnu...anrnz�ss O OtVNER �r-zaua,. STATE LICeNSB # a�n�ss-�l4i �'3II3GLE FAMILYlNEW CONS'IRVCTION ❑ TWd FAlvIILY/NEN CONSTRUCfION LTiAD C&RT �E��i!�1'Z' ��' 0 ADDITf4I3 Ei G� GElSHED 0 PA3EMENT FIh'I3H B^'le x ❑ D�cac o smrN� ' � SiVZMI�ffNG PO(7L �1"X�� F WQRIC� l� 1vP.W tin�,n? t�nNSTRrrr,�nN t7 AIfPT110N �',C�fAINTENANGE�REP.0.IR 0 REMODELINCr DESCRIBE wpRK J3.L•'�NC+ DON£: °� � SIZE OF IMI�ROV$A.{Fj1T � � �� %'�� SQUAPES �� ❑ ��SE � GAitAC3£ RA ... QR��FOSEb SIZE: -- - ��-LiE"�Af�D GARAGE PF20POSTD HEIGHT; ��r ❑ WINDDIIJS � 17RAIN Ti�.� � �THF?R ��t �o.: �� Date Rec'd: =- t r 1 __ sr.a� �n z� �A�rM1�T 'Rr3 ODE7 iNC SUSMI7` I. Existatg F1oor pLn 2. Ptopostd floor plan 3. T„ixt of wtrucmeaj membeY6 tb be uacd SIbING 1�vx tvk.w t,;VNJ'.l'aiUC:'A'AVN LNCLUll1NC'rUECICS, ❑ Vinyl OSo£Gt '� ADDIIYONS � F4R T�,JR �T: CI Aluminum � Trim t. Siu Fia�tlSwvey aiiowing thc czieting atrucLUres G bkhcr � �. 0 Fnavia snd pmpo9cd pmjxt ��y�,yyfi 2. 7wo aets of construction pIat�d I1V E7sZ5TlNG qFENfNGS 4Yes UNo l.ocA�rtorr oF wn�rppw3 3' �n�rgy Caicuiat�ons OR F012 NEW p�TTR.I�',.5-D&SCRID& SIZE OF �'OR t'UiNDt�wS Y PROVTbE u-v.ar.[7� ,qt�rp OPE��if+IG CFi.4NGES l$ MANLJFACTURE 3TICKER bN W�qw, 7�'PE OF k7MadR%TO SE INSTALLED NUMBEit OF WINDDWS ,A,LL FEES ARE BASED ON VAL'U'ATiON TNCT.imnvc� �[� rosx� o� r�o --• .-� roTai. �aB vn.z,� 1>e7m it 7'ee �lan Review F'uc Surcharge Surchargc License Surcharge 5AC Ck�axge [:tzrb L:ut Escrow ErUSion CorYfiol Pazk Fee Sewer, �vl,sit] C1iRTge Tot.�l Due �t aivn 1�A (TJ$�1VG THE 1997 U B.0 �E SCHEDULE) _ o�crrPA.1vcY � _�-5 s�� k r� � r�� s4�,�au�G 65% of Buildiug Perinit Fee � _001 times �e totaI job valuatioz� .0005 X PEYYriit Yaluat�pxl Mu]�tum $S.pp " �t" $5.00 (SCaCe Licensed Residential Contrsctozs) �,� �2230 per SA,C Unit (P1ams uo 1v�WCC for detcrminat�v�) fk+bft�,._. ftx$25=$ --- $450 Co�servat�an PIan Review . k'ee l�eterniiiled by Engineet�S A�rccmart necossarY ( ) 1�on NecessarY ( ) �- M�ke CF�ec�s payable !o: Citv nf Fridlev d1+uw rt-BS rs pza�caaors sax n�x�r7C-zval' v.9i,iTi uN ru, rxVC�:ssY:u I hereby appIy for a bui�divag permit and'I actrnowladge that thc informatiom above is complete and accuratc; that the tvork wili be iz� aonSarrnance w�th the ordinanees and eodes o� tiae �ity of Fridley and with rhe 'Minncaota Co,�sttuction Codes; that i wnderstand this is nnt a. FGrzn�c but only an applicavon t'or a permzt aa_dVriiork is not ta stazt without a permit an sAte; tha.t the work rr�ill be ' ordance wit�a the appx0�� 18i] iri ttle case 0 � w4fk U�1'es review a�d appraval of p -7� SiGIvATURE Q�' ,r�.FPL�CAN?�� PRWT NAN� �7� �� . DA'�'� ��` !' Z' .LPPROVALi�.;�+��TORwIC AIU12� �