AF - 34264!
�
�,
�
E
c�
a,
>
�
ti
4-
�
W
1—
�
. �
t�
�
�
� �
A Q
•-.+ 't�
�
LL A
Z
l.L Q
O �
Z
M
� g
U �
�
�
�
�
O
F-
Q
V
�
_ .�
a
¢
�
�b�, 8
���ro
H � � � �
� �-� � m
��m�
�°���° �
� w 3 �tl C
r� � o� a"�+
v � �
a���
ro o a
� H �i � m
�. �'' � �
M C U W ,G �
��� �e�i N q �
J�1 11 +i R
V � � � �
�x�0� �
M id � o m w�
` / �
0
� I�i
_,
�
1
°z
H
�
a
�, '� � 1 0 �� �, z°
�6. � � � - - E
b+ '�' �o c�'� �a
� � m a°� � w
, �•�+ v a�w �a �
�?� C m�H x �
w �-01i �°n „d'i � o � � � � � o]o
o �u sr m b+
�� �o� �w�� o � c� � �
� � m«a�w a � w� � �
h � U E � m �� � D4 � H W O
�� �'
� � �
� �+ ri
v�1 E
�
�
�
�
a
�
�
� �
� �
a
0
w
�
�
,
a
F
O
H t? tll N N tl► t? 41 N f/1 t? N N t? f?
O O O O O O O O O O O O O
W O �f1 �11 O O O O O O O O O p �
. . . . . . . . . o
a u1 nf r-I � �n 'tn u1 �tf �A t� u1 0 0 ,� ui
W �-1 �-I
N t? N f? t? f? f? H N t? N f? t? v y.
I I �
8 z I I ^ I
Cn m
w
�
� '
py � \
N �
� x �
Y �
W � � +i
E. � F ..� "�
a� a �
N m m R 4 N H
� FI � m �ri m „`I �ei q � �
5 .�
� w e"a a m o�tla ,°a w s m�°7 �
a�+ �+ a m a, � a d►, m w a
i7 Pu �' 0I W �tl +� +1 M m 0+ m � G1
� � m o, a o°D 3� o H ro°►�i �, �
�,y W M O .ei ttl M 3� q py
� a� ro m o.°+ �.°, b e i+� m m x
� z w o ama o'�a cidi a m v�i � a°a �� �
a
a
0
0
�
w
N
H
H
W
�
a
z�H
�U
a u�i
a+ w
� aH,'
O�
w�
w`�
w
�E
Na
�a
�
�
N fq� y
01 W
b+ t4
il
ro a
z o @�i
E a� ai E
� U
� m
a � �
� a H
a a
� H
O
N ia
a � $
i:i +I N a
� y v
a
�o $
w
� �
� o
�pp�� � �
H w �
o � a
� '�
� .� �
�
�
' sue�ecT PER
City of Fridley ? 4! G 2
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �`y _._��_ COMMUNITY OEVELOPMENT DIV. RE T NO.
r � � PROTECTIVE INSPECTION SEC. ��
1 = �
� �"'1 � CITY HALL FRIDLEY 55432 NUMBER REV DATE vpGE OF APPROVEO BV
�""'"� � ,'� 612-571-3450 910-F15 11/8/96 / /
JOB ADDRESS 6213 Able Street NE
1 LEGAL LOT NO. BLOCK TRACT OR AODITION SEE ATTACHED
DESCR. iS-17 2 Moore Lake Hi hlands SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Brian/Chris Yone 6213 Able Street NE 574-2314
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Same
4 AHCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS Z�P PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW ❑ ADDITION O ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install e ress window in basement bedroom
9 CHANGE OF USE FROM � TO
STIPULATIONS
Window must meet the State Building Code.
SEPARATE PERMITS AHE REQUIpED FOR ELECTRICAL, PLUMBING, HEATING, �PE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. N0. OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALI.S GAFiAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND OHDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �300 �.SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEfiM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
UCTION OR THE PERFORMANCE OF CONSTRUCTION. �Z1.00 Fire SC �.30
PLAN CHECK FEE TOTAL FEE
$21.80
ATUREOFCON7RACTOpORAUTHORIZEDAGENT IDATEI HEN PqOP RLY V DATED THIS IS YOUR PERMIT
�
/r 9 � T
S�GNATURE OF O P Ui OW R BUIIDER� iDA7E� . � ip piTE
NEw
ADDN
ALTER
�]
[l
[l
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R 2
Building Permit Appiication
Effective 3/1/96
J��
9
ConstructionAddress: �2 / � � i3 r� ��, ,(,I , � �
Legal Description: ��S o i.,.zy.;� ��', .�}�L�; o�-��� �,��.
Owner Name & Address: (�,�,� g C �,,r,� �d,�� �/ Tel. #�'��! - 73i y
Contractor: p l„� � p„/ MN LICENSE #
Address:
LIVING AREA:
Attach to this application, a Certificate of Survey of the
lot, with the proposal constniction drawn on it to scale.
DESCRII'TION OF IlVIPROVEMENT
Length Width - Height
Tel. #
Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECg AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: ���S�II S��rpSS w,Hd�� �•� �'✓�Se,c�e,•��-
�fo� wc
Coraer Lot [] Inside Lot [] Ft.` Yd Setback '`` ' Side� Yard Setbacks
Typ� of Construction: ' Estimated Cost: $ �o O
Approx. Completion D�te: . � .
. . (Cost on Back) �
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �r �' q� APPLICANT: � Tel. # S 7zl - Z 3 i�
Permit Fe,e
Fire Surcharge
5tate Surcharge
SAC Charge
License Surcharge
Driveway Fscrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ o�/. Q�
$ • � .��
� S ��
$
$
$
$
$
$
$ �/�-���
CITY,' USE ONLY
F� Scheduie on Reverse Side
.�1 of Pennit Valuation (1/lOth%)
$.50I$1,0� Valuation
$900 per SAC Unit
$5.00 (State Licens�d Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.� Conservation Plan Review
Fee Determined bY Engin�ring
Agreement Necessary [ ] Not Necessary [ ]
-4.� - -
SUBJECT = PE
c�ty of Fridley ' 2 6 0 3 0
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
�
� �
� � COMMUNITY DEVELOPMENT DIV. ����
� jL ��..��,
r � � PROTECTIVE INSPECTION SEC.
i . �
i.--. ��'�h ,� CITY NALL FRIOLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
L �� 612-571-3450 s�aF�s 5/7/98 / /
10B ADDRESS 6213 Able Street NE
1 LEGAL LOT NO. BLOCK TRACT OR AODITION SEE ATTACNED
oescR. 15,16,17 2 Moore Lake Highlands SNEET
2 PROPERTY OWNER MAIL AODRES$ 21P PNONE
Brian/Chris Yoney 6213 Able Street NE 574-2314
3 CONTRACTOR � MAILADDRE8S �P PHONE. LICENSENO
Same
4 ARCNITECT OR DESIGNER MAIL ADOpE88 21P PMONE LICENSE NO.
5 ENdINEER MAII ADDRESS Z�P PMONE LICENSE NO.
8 USE OF BUILDINO
Residential
7 CLASS OF WORK
O NEW O ADDITION � ALTERATION C� REPAIR ❑ MOVE O REMOVE
8 OESCRIBE WOHK
Tear-off and reroof flouse (21 Sq)
9 CHAN(iE OF USE FROM TO
STI PULATIONS '
Underlayment must comply with the State Building Code.
SEPARATE PEHMITS ARE REQUIRED POR ELECTRICAL, PLUMBIN(i, HEATiNfi, �PE OF CONST. OCCUPANCY dROUP OCCUPANCY COAD
VENTILATING OR AIR CONDITIONINti.
THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION 20NINfi SQ. FT. CU. FT.
AUTHORI2E0 IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED Oii ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLfi. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX
AND OROINANCES GOVERNIN(i TFIIS TYPE OF WORK WILL BE COMPLIED @
WITH WHETHER SPECIFIEO MEREIN OR NOT. THE GRANTING Of A PERMIT W2f16H �1.OS
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATIN(i CON-
STRUCTION OR THE PERfORMANCE OF CONSTRUCTION. �74•7S F e SC �L.1%
PLAN CHECK FEE T L FEE
78.��
NA�FE OF CONTRACTOR OR AUTNORI2ED AGENT IDATEt E R ALI D TMIS IS YO R RM
� � � �-�-g� , ' _
SiGNATUREO� NEpUi � NERBUILDER� IDATEi ���g INSP 4aTE
NEW
ADDN
ALTER
�l
[l
[l
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: �D� � 3 ►q-�l e s-�' . .� • � '
Effective 1/ 1/98
� ���� �
Legal Description:
Owner Name & Address: ��t�-� c�^d;S �oKe`� Tel. # �?�" Z 3� �-(
Contractor: �� � �3�— MN LICENSE•#
Address: ��e �� �� e�-e. Tel. # S? Lf - Z 3 t'-�
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width
Length Width
.N�� _ s�o��
Height Sq. Ft.
Hg�lGround Sq. Ft.
` ,
Construction Type: �iec..� ��''� Estimated Cost: $ � ��� , "�1 ,�� `�1
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �? �? �i APPLICANT: d��uu� Tel. # �7 � - Z 31 �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
TOTAL
. STIPULATIONS:
$ •%
$ , 7
$ .�
$
$
$
$
$
$
$ ��', �'
CITY USE ONLY
Fee Schedule on Reverse 5ide
.001 of Permit Valuation (1/lOth%)
$.50/$1,0� Valuation
$10� per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.� Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
G � � �
suerecT MIT PFO.
City of Fridley � 2 6 7 5 8
AT THE TOP OF TNE TWINS g U I L D I N G P E R M I T
� � T NO.
� • COMMUNITY DEVELOPMENT DIV. �� ��
� j y �������
r � � PROTECTIVE INSPECTION SEC.
1 . �
i---- A��'�';� CITY MALL FRIDLEV 85432 NUMBER REV DATE PA6E OF APPNOVED BY
L •�� 612-571-3460 910-F1S 7/22/98 � �
�oe a�opess 6213 Able St NE
t LEGAL ��T NO. BL�QCK TRACT OR ADOITION SEE ATTACMED
oescR. part of 15 16 17 2 Moore Lake Hi hlands SHEET
2 PROPERTY OWNER �IAIL AODpEB$ 21P PMONE
Brian�Yone 574-2314
3 CONTRACTOR MAIL ADDRE33 ZIP PMONE • LICENSE NO.
Four Seasons Roofin & Remodelin LLC 7930 Universit A NE e
4 ARCNITECT OR DESIGNER MAIL ADDRE88 21P PMONE LICENSE NO.
20138 8
5 ENdINEER MAILADDRE88 ZIP PMONE LICENSENO.
8 USE OF BUILDINO
Residential
7 CLASS OF WOFiK � REPAIR O MOVE O REMOVE
❑ IdEW 0 ADDITION ❑ ALTERATION
8 DEHCRIBE WORK
Reroof house and ara e(21 S) Tear-off
9 CHAN(3E OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBIN(i, HEATINd, �PE OF CONST. OCCUPANCY (3ROUP OCCUPANCV LOAD
VENTILATING OR AIR CONOITIONINO.
THIS PERMFT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION 20NIN0 SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 OAYS, OR IF CONSTRUCTION
OR WOHK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAVS AT
ANY TIME AFTER WORK IS COMMENCED. NO. 01NLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFV TFIAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORHECT. ALL PROVISIONS OF LAWS yALUATION SUiiTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE t3RANTiNG OF A PERMIT �1751 �:$]
DOES NOT PRE ME TO GIVE AUTHORITY TO VIOLATE Ofi CANCEL TFfE pERMIT FEE SAC CMARGE
PROVISIONS O AN TE OR LOCAL LAW RE(SULA INfi CON-
STRUCTION THE P FORMA E OF CONSTqUCTION. �SC).7S �I.7S
� Z�� PLAN CHECK FEE TOTAL FEE
License SC $5.00 64.37
� GNATURE OF CON7RACT0 OR AUTNOR�2ED A6ENT IDAi i MEN PROPERLY VA TED THIS IS YOUR PERMIT
� � �! ��
S�GNATUNE OF OWNER ��i OWNER BWIDERi IDATH - B�pG � p OaTE
�w � � : , Effective 1/1/98
ADDN [ ] , .. , . CI'l�y�OF FR.IDLEY . � .. �
�I� S� �'��.... F'�.. � . .. �
ALTER [] { SINGLE FAMIL�,�AND DUPLEXES R 1� AND R 2
. ., �t1ILDINCi'�PERNIIT APPLICATION , �,�
. . . �� , , .. � � . .�.... `�,: . , . ' ';u,� .�r . r . . �
" . ' t �i . • . _ . . . � '�:ih .. �.. . �
ConstructionAddress� �,: b ; t r� �,+ .��
: - -e.t ,•� s . . . .... � c .. . � , . . _,
Legal Description: � � . ,
Owner Name & Address: �! �t,n �On �� �4 Tel; #�'% ��o� �/�,i
Contractor• �U cJ r s eCc�S cm S� o a-� �� �o i� �' M� ��SE #�� 7��
� _ .. l�`..3-'� � ..
Address: %g 3 d LJ vt � U e�� ��� U f- /V �� Fr ► c� I Tel. �%�5 �,llD
• � '� Attach to this" application;� a Certificate o� Survey of the .;� *�,
lot, with the: proposed con'struction drawn on it to scale.
. . . DESCRIPTION:;OF 11ViPROVEMENT , . -
. . ,�, , .a�yo:; . . , .
LIVING AREA: Length � Width Height Sq. Ft.
GARAGE AREA: � - � Length ' ��.` � . , - Width . Height Sq. Ft.
DECK AREA: � ; ,t` k , ; �; .
I,,ength � ' • � ` ` Width ' � Hgt/Ground � Sq. Ft.
OTHER: � Lt'lrr O V (�.. �a�,p ICLC �� I,�A G� SG1 t n4 �� �_
. : .. � . .
Construction Type: V2.cL- Estimated Cost: $ / l�� A ,' .
;
.� ... . . � � :' . � . . - (Fee Schedul e on Back) � . .
Driveway G�rb Cut Width'Needed: `���� � Ft.'�+'6 Ft = Ft x$ _$ �
�— Tel. � '�� � I�11�
DATE: . � �j � APPLICAIVT: ,
. � . . � ,, . : ;,�� _ ;;'YS;ITY�. USE ONLY . ;� . �.�;
. , ��: .
, . ..._.. .. . , � ,
�/ �' �'�;��� � : . :.; f ::; • , �
� s.:
Permit Fee $� �(d. �%"` �� Fee��Schedule on Reverse Side
� 6 r �
Fire Surcharge $ .����`OOi�of`Per�nif`Valuatioa (1/1.Oth%) , , ,
State Swrcharge $ � � �r`` $:50/$1;�OgValuation �
SAC Charge: .. ; 4 $ =, $1000��r SAC Unit , , ,, , T,p s� ,.,,t,�0cy
;,.� ,,. .,,:', �: � ,.,.��„ . . ... ,+ �::,.� . : .. . ., , . x l.i .v_, .Nii S` r �. 53r`7,7�p.. .
� �-. � �, � �"a �
License Surcharge $ � C%��; $5.�: (State Licensed Residenti�l �Contraato�'s�� �, :�,;. z,. ' � _ �.,=�,.s_�. _"
Driveway Escrow $ . � ' � ' �` A1f : ' "A" or Alt. "B" Above � ° 4' � � * t �� ;-� �: ,
Erosion Control $ � t�� $450.� Cons�erv�tion Plan_�eview
�a.. �� ._. F���:
Park Fee $ �ee Detern�ined by Engineering .:
� �ewer Main Charge ° $ k`�' � �'� Agre,�ment Necessary �[ � Not I�e�cessa�►�� ]�, 4 ",������,'� � �
. . , s . �. � a, lr <;; i ,�. 8�' �C
. .. . � .+�.:"1 . - " s S.�".�.. �_'_' +. .. . . � . . .. 5:.i � v''' . � ,i��n�� �,���r��� �..f ,i �.-
;' �
.,. �;�. ��. ' a�� ... ,. '.�� .
TOTAL _ $ . _
, }� �
c�:�s.. ,.i .r� . :s,i F,�i ����d��i�`t ..°i �4�,'Y.r3���4��-'�
� . .. .. �.� � i � 4 i.5-�dp�v;�Z��'�`•+ As T �i�S��i�f����r��S .�.C.�',
STIPULATIONS: .
... . _ p { � ' .., -. . . � .. .
. �i f
. ����.� 3
S�
� City of Fridley
AT THE TOP OF TME TWINS
i�
� �
� ; v ����� � COMMUNITY DEVEIOPpAENT OIY.
r � � PROTECTIVE INSPECTION SEC.
1 = �
� �""1 � CITY MALL FRIOLEV �� Nu
�""'� � �'' 612-571-3450
108 ADpRESS 6213 ABLE ST NE
t LEGAL LOT NO. BLOCK TRACT OR,
DESCR. � C '1 ti'I 7 2 Moore
Y6111UV W Lt {,G O�i V V �
4 ARCNITECT OR OESIGNER
S EN(iINEER
MAII
�U ILDING PERMI
s�aF�s
RBV
13/QO I �
OF
/
31055
SEE ATTACHEO
SNEE�
21P PMONE
763-586-Q575
iIP PMONE IICENSE NO
�45 763-425-2227 2003925
ZIP PMONE LICENSE NO.
21P PFIONE LICENSE NO
7 CLASSOFWORK � NEW O ADDITION ❑ ALTERATION �] REPAIR O MOVE O REMOVE
B DESCRIBE WORK
9 CHANGE OF USE FROM
STIPULATIONS
Provide Smoke Detectoxs in a11 sleepi.ng rooms and on all levels of the
dwelling per Sed 3i0.�.1.2 1997 Uniform Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAI. PLUM81Nti, MEATIN(i, ��
VENTILATING OR AIR CONOITIONING.
TMIS PERMIT BECOMES NULL AND VOID IF WORK ON CONSTRUCTION 20NING
AUTHORIIED IS NOT COMMENCED Vt(ITMIN 80 DAYB, OF IF CONSTRtJCT10N
OR WORK IS SUSPENOED OR ABANDONQD FOR A PER100 Of 120 OAYS AT
ANY TIME AFTEIi WORK IS COMMENCED. NO. OWLG. UNITS
I HEREBY CERTIFY TMAT I MAVE READ ANO E%AMINEO THIS APPUCA?ION �.
ANO KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISICN$ Of LAW$ VALUATION
AND ORD�NANCES GOVERNING THIS TYPE OF WORK WI�L 8E COMP�IEO �3, 847. OO
WITH WMETMEii SPECIFIED NEREIN OR NOT. TME GRANTING OF A PERMIT
OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TME pEqMIT PEE
PROVISIONS Of ANY OTNER STATE OR LOCAL LAW REGULATINO GON• d�9,, � 25
STRUCTION Oii TME PERfORMANCE Of CONSTRUCTION W
PLAN CMECK F
Licen S
S�GNATUAE O� CON'AACTOp OR AUTMOA�ZED OGENT IOATp� y p,
� ��
STAII.S
$5.00
CU.FT
GAAAGES
SURTAX
r $1.92
SAC CNARGE
Fire SG $3.85
, TOTa EE
108.02
�ono
y�V�i
rrEw
ADDN
AI,TER
[]
[l
[l
CI'I'i� OF FRIDLEY
3INGLE FA1V�Y AND DUPLEXES R 1 AND R 2
BUILDING PERMIT APPLICATION
Effective 1/1/99
/
��/��
s�`o �� 1
ConstructionAddress: _�2,. � „� �1� �k l�l E
Legal Description: ' - � - . J _
Owner Name & Address: �Q,}{, + R hond►a� C-t� c�t�d, e_t'SOtI Tel. #(?bai 58'!0 � OS7�
Contractor: ��t�dow 1_� �� MN I,�CENSE # Z DO 3Li,2 �S�
Address: $400 - 8�1'�� l�le, _ IJ .� 410� Qrpc�Klun Par K ti"�t�l SS4�+S Tel. # �76�i 4ZS-Z2Z �
Attach to this application, a Certifieate of Survey of the
lot, with the proposed construction drawn on it to scale.
� - DESCRIPTION QF .IlYIPROVEMENT . . :.
LIVING AREA: Length
GARAGE AREA:
DECK AREA:
4THER:
Width Height
Length Width Height
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: ' Estimated Cost: $ 3$ �1,"1 � d
(Fee Schedule on Back)
_ _ _ . -- ._ -- -
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
na�: 5- 3a - o°�o
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License 5uFCharge
Driveway Fscrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ ,�5
$ �3��
$ ��
$
$ � 01�
$
$
$
$
�� ��
5TIP TIONf� �6�y��
�� ��
��� �ld� �� l. �.
CITY USE ONLY
Fee Schedule on Reverse Side
.�1 of Permit Valuation (1/lOth%)
$.50I$1,000 Valuation
Te1. #�7(a3i'-+ZS- ZZ2 �
$1050 per SAC Unit
$5.� (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement NeEessary [] Not Necessary E-]
/�tOi� �t�%��i��-�l iG��L- e:��/��'��
�
fz��L- •l�?/�� 0�7-�'� �l��G�-�-��--��
1��� ���► c�