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Inspections
763-572-3604
763-502-4977 FAX
BUILDING
COMMERCIAL/INDUSTRIAL
CITY OF FRIDLEY
EFFECTIVE 1-1-2011
�",.� r +� �'j C`'
Permit No.: � �� ��'
Received By: , �
Date Rec'd: a �
DATE 1�' �� ' J� YOUR E-MAIL ADDRESS NP�J D�2S�Gn �-�v[ n� c� �
SITE ADDRESS ��OO ^Z S � �'✓�. �'E ' "
TENANT G�ar.c. C�v�l.r'CGiI �C
Suite No.
PROPERTY OWNER NAME: G/'�� �-t/7 �t �'��t CJ�t ✓�c-G�
ADDRESS: �f(p0 �S�- fl+/�- �'�• CITY �'i�STATE"�:'LIP ss�f�' Z
PHONE:
ARCHITECT
CONTRACTOR
* NOTE: CITY
LIC�NSE REQUIRED
COMMERCTAL,
INDUSTRIAL AND
MULTI FAMILY
PROPERTY TYPE
PERMIT TYPE
PLEASE SUBMIT:
NAME:
ADDRESS:
NAME: N��/
CITY STATE ZIP
ADDRESS: `J�YF�i ��T-• /�1,GP��l`� J CITY�STATE� ZIP S✓�3 ��
PHONE: i�o l Z- ���� 6`� T FAX 7�v 3 � Z-y �-� 7��'
❑ TOWNHOUSE �f-COMMERCIALl1NDUSTRIAL ❑ INSTITUTIONAL
❑ MULTI-FAMILY
� ADDITION ❑ NEW CONSTRUCTION ❑ OTHER
L4REMODEL ❑ ROOF � SWIMMING POOL
1. 4 SET SETS OF DRAWINGS 5. CONTRACTORS OR LICENSE 8. 1 SET-DIGITAL OR ELECTRONIC
2. SURVEY/SITE PLAN LICENSE APPLICATION PLAN
3. LANDSCAPE PLANS 6. SPECIAL INSPECTION SCHEDULE
4. ENERGY CALCS 7. PERFORMANCE BOND AMOUNT $
BUILDING TO BE USED AS: OFFICE sF WHS sF OTHER sF
TOTAL SIZE:, STORIES FIRE PROTECTION (Y/N) AC(Y/N)
DETAILED DESCRIPTION OF WORK
THIS IS AN APPLICATION FOR A PERM(T-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and 1 acknowledge that the information above is complete and accurate; that the work will be in
con%rmance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT :
r:z�
���'�"'�`� � , �" \ PRINT NAME: KQ��/1 S�'�j0 a �"O� DATE: � r Z' 7���
ALL FEES ARE BASED ON VALUATION
Sq. ft. x$ Cost/sq. ft. = Valuation $
Sq. ft. x$ Cost/sq. ft. = Valuation $
Sq. ft. x$ Cost/sq. ft. = Valuation $
COTAL JOB VALUATION: $ -�—Y 30b °'O USE
'ermit Fee
'ian Review
'ire Surcharge
Surcharge
3AC Charge
?rosion Contro}
�ark Fee
ipecial Assessments
Cotal Due
�' J a �l ����I
OCCUPANCY TYPE
$ /�/, 02-5� See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ i .001 times the total job valuation
$ �� �� .0005 x Permit Vatuation Minimum $.50
$ $2230 per SAC Unit (Plans to MWCC for determination)
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ i . e Make checks payable to: City of FridleY Attach