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BUILDIiVG
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
Permit 1\TO.:
Received B �
y: ;
;ATE 5 l � � � ��% YOUR E-MAIL ADDRESS � O C( � �J � .� � (�!�' ,� l� �,i � , rn M
�T� ,�r»xESS c t� o ��^ sfi. jK' F_
" TIS APPLICANT IS: ❑ OWNER �CONTRACTOR
:'ROt ERTY OWNERJ
TENANT
CONTRACTOR
SUBMIT A COPY OF
i;piJR STATE LICENSE
`TJITH APPLICATION
PROPERTY TYP�
P�RMIT TYPE
TYPE OF WORK:
�r SCRIBE WORK BEING
�LE OF IIvIPRflVEMENT
�- rOFING
u�MBER OF SQUARES _
ARAGES
' OPOSED SIZE:
ZOPOSED HEIGHT:
DING
Vinyl
.4luminum
oc��
.a.DDx�ss: L I 2 D` 7 r'� S-i� �Y � ciTY_
PHONE:— [ � 3 1 5_I_ �'� � L�
Pella Windows & Doors —
N'at�E:_ 15300- 25th Avenue N.- Suite 100 -
STATE LIC P��OUill, MN 55447
aDbxESS: �63/ 745-1400 —
PHONE __
t�crrrr,r F License# 20165884 �F
❑TWOFA�
Q ADDITION
❑ BASEMEN'I' FINISH
❑ DECK
MATNTEIaANCE/REPAIIt
►ONE: l0 %� l ri cl o l�
Q GARAGE/SHEI
❑ ROOF
❑ SIDING
❑ SWIMMING PC
❑ ADDITION
❑ REMODELING
/` � / n.�.r�.
❑ HOUSE �I1LY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ F��sa
INDOWS
cXISTING OPEN]NGS� es �No LOCA ON OF WINDOWS
Z=0R NEW OPEI�IINGS DESCRIBE SIZE OF �� d ro o r�n �
'�NING CHANGES & •
:'PE OF WINDOW TO BE INSTALLED D� S NUMBER OF WINDOWS L
CITY
. ORIES
� WINDOWS
❑ DRA1N TILE
❑ OTHER
HEIGHT
ATE_ZIP 'j� S �! 3 �
TE ZIP
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floot plan
3. List of structural members to be used
Ft°P��' �
FOR NEW CONSTRUCTION INCLUDTNG DECKS,
ADDITIONS. & PORCHES SUBNIIT:
1. Site Plan/Survey showing ti�e existing shvctures
and proposed project
2. Two sets of construction plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(FISING THE 1997 U.B.0 FEE SCHEDULE)
. TOTAL JOB VALUATION $ L�I � b OCCUPANCY TYPE
:mut Fee --
an Review
ircharge
�e Surcharge
cense Surcharge
=.0 Charge
�rb Cut Escrow
osion Control
rk Fee
wer Main Charge
�tal Due
$ 139.�
$
� 3. ys
� G.W n
$ S,bv
$
$
$
$
$
$ / S �/, l, v
See Back Page for Fee Schedule
65% of Building Permit Fee
(.0005) times the total job valuation — Minimum $.50
.001 x Permit Valuation (1/10%)
$5.00 (State Licensed Residential Contractors)
$1450 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMTT-NOT VALID UNTIL PROCESSED
iereby apply for a building permit and I aclaiowledge that the information above is complete and accurate; that the work will be in
nformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
rmit but only an application for a permit and ork is not to start without a permit; that the work will be in accordance with the approved
in in the case of all work which requires vi nd approval of plans.
'rNATURE OF APPLICANT �� PRINT NAME l l�" � S� � 1� n �C DATE �( l 7 l��
S