P - 39840Building B��Y�.�3�.NC�
Ins�peciions � �ESI.�DENT�A� ApPLICATI4�3
763�572�3604 � ���� ��' �`��,�Y
?63-502-4977 ��� ����v�1.�.zorr
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THIS APPLiCAN'T FS:
TENANf'
SUBMT'i' A COFY OF
YOUR STATE LiCEI�tSE
ANZ? CER'1"tFCCATE OF
�rs��►:
TYPE OF
n�scx.tse wox�c e�aiaG
�a o c ,
Nt34(HAR nF SQUARES !
S�}ARAGES
FRO�OS�1? SILE:
FRdf�$ED ECECGM':
smnvc:
❑ Virryl
O Alumimm�
I7 0�6er
wnvnows
tN &3t3S7'II�iC OP�NTNCS Olicsj
OR FOR NEW OPEMNGS-DES
dPENWG CHA3�TG6S & i
ALL
perm,c Fee
�'tan Review
FirC Surcharge
SuFCI1Af'$C
License Surchsrge
SAC Charge
Curb Cuf �scrow
Erosian Conirol
Park Fee
Sewer Main Charge
❑ OWMER
c�e�a,rs�
SINCLL• FAMiLY/L�}EW
TWO FAMILY/N�'iV CG
BASEMEhi'T F[N1SH �RQCI�
DECK C7 �II�tNG
� 5WFMMING P40L
N�t�U 1'i4ML COA1SYkUCTIOk ❑ ADDI770N
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1.FI+�Oi'H Wi[�TH
,[ ❑ �aus�arn.v
,�7�� � HOUS& & GARAGE
L7 ATCACNED GAI2AGE
d DET'AC�D Gt�iinc��
FAX
❑ WiAID�OWS
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Permit No.:
Recei�ea
M ��y.�,i 4 �
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kdA3�MFNi' REA?iC7U�LTbIC`i SIIBMCT:
I, Existing Flaor PL3n
?. Ptpppspd tlbt�t p1�t1
3, List of structuz�l mcmbcrs to be resed
FE)RAfEVJ CONSTRU�'fIO1V iNCCIIDINC. �ECK$,
O5ofF1 �C?ITIANS..& F[]RCl•iL•S SUf3totlT:
O 7rim L. Sita P9�Survey 5howing the erisling suuci�aes
O Pascia 2. T o sets� qf e.arrsvuctfon plans
s. ��e•�ry c����a����ss
E7Na LQCA9"CpN Ox Wlt+tY)OWS FOR W1.NDOWS - PFtOVIbE l!-VAX.�,1� pN�
CR1'$� 512�1E 0� lutl+.NUFR4'�i� STCC(C�R f1N w1NAOW
0.LLED NCTM'BF,it. pF �VlN1�]WS
�S�II ON YA�,UATItiAf, IiVCLIJDYNG 7`� C(l$'1 �F T,ASUR A1VA MA iT�RIA�.S:
([iSINC Tii$1.99'I CI!.B.0 F�E $CYiEF)�CfLE)
S a laf�['"If1DAl►T!"V �rvLY7nt+
� `L `1° li' 1,.� See.BackPag� for�'�e Schedute
�� b59'o afBuils�ing P�rmit Fee
� �i? ,� .001 times the tota( jab va3uati�n
� � i� .0005 x Permi# Valuntion Min'smum $5_00
� --- .�iCi1 $S.QQ (StBic LicensCd Residential CUntractors)
� $223U �ser 5AC Unit (Plans t+u MWCC for deCermination)
$ ft�+-��_� $�Sr25=$
� _..
$ �454 Conservatir,n Pta� Re�iew
� �ee. Det�rminect by �ngPneering
$ Agrcomcnt necess�ry ( ) "Nan Nec:c:ssary ( )
$ �� : M�ke cLeefts ngaflhlp M� C.itv nf x'��.11a., A H,n.�
Ti-D3 iS AN f�PP1.ICAT)LiJ�1 CdR A P�'l7MtT-N47" VALiD UNTtL PROCS5SHD
I hereby apply for a t�ui.lding permit and t ac�CCnowledge that the inFormation ehove is comp{ete and aacurate; that the work wilt be in
epnformance arith the �r '� and c es nf the CiCy oi Fridtey and vrith th� Minnesota Constructian. Codes; that C understand this is aQt a
perrnie but oWy an appli ion ar a i aad work is not to start ��ithout a permit c,n site; thai tlie worEc wiil be i�t. a�o'Cdprtee with Che
approwed pl� in the cas a` o i d a{rpro�+al af s. ,! '�/� r�
Sl�GNATUREOFAPP4CC P.RlNTNAM��� ��C' l,�sr ti DA'C8 �� �� ��
ep6RAVeY Y1.MOr.Ywrnn arr_ w r_ � .
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