P - 35794Building BUILDII�I�G p��jr Na.:���v
Inspections RESIDENTIAL APPLICAT'IQN Received By�
763-s�2-360� CITY +C�F FRIDLE'� D °a
763-502-4977 FAX �r-�ECTTVE �-i-zoi � ��� , ���� j
DATE �I �� 1 � Yav� �-t�.an. �pDx�ss � �-� v°. � �s +"��4x�k_-Ie°�r`�}1�,�-s- C't� m
SI7'E ADDRESS -�`l �J " � -
THIS AFPLtCAhfT IS: Cl OWNER i�LONTRACTOR
PROPERTY OWNER! �A�: ' '
T"�NANT ADDRESS:�`1 �` �-�j C S�i .�CI'f'Y t c� I c.ui STATEfI�' �,�IP ��
PHONE: iQ � Z. '�j� lr? '� 3�� T
CONTRACTOR NAI�E: �d�i`h.e_r Lr �� c� - n
SUBMTT A COPY OF STATE LICENSE # c� Q�j jQs,� �`1 � LEAD CERT Ni;;14BER F� '.L ° I S J( S" ��` C��'"l � O
YOUR STATE LICENSE
AND CERT[FiCATE OF ADDRESS: c�-�,'7CP �• i I`� t�` .S t° CITS'�,�l1"C�Vi ll � STAT�ZiP,�S �'-j
IN��� PHONE � sa- scay - Fa�c .
PROPERTY TYPE SINGLE FAMILY/NEW CONS'CRLTCTION s� „�,? i.�o ��
0 TVJO FAMILY/NEW COI+iS"fRUCT'IQN STORIES
PERMIT TYPE ADDITION ❑ GARAGEISHED L7 WiNDOWS
❑ BASEMENT FINiSH (�RUOF ❑ DRAIN TILE
O DECK ❑ SIDlNG � OTHEK
Cl SWiMit�P1G POOL
TYPE OF WUitK: O NEW HOM£ CONSfRUCTtON ❑ ADDITiON
� MAINTEPtANCE/Ft£PAIR CI R�MOAII,TI�TCr
DESCLiiBE WORK BEING DONE: RG_�R�c' i-
SIZE OF IMPROVEMENT ` LENGTH WIDTIi HEIGfiT S FT
❑ HOU$E ONLY gpg�p F_ D I_INC. SU�3MIT:
� F SQUARES �� �HOLTS� & GARAGE � ���g F�� �
�f� �TTACHED GARAGE 2. Praposed tIocx pfan
PROPOSID SIZE: ❑ DETACHED GARAGE 3. List of stsuaurel members to be used
PROPOSED HEtGHT:
� fOR NEW ('ON5TRUCTION INCLUDiNG DECKS,
❑ Vinyl OSoffn ADDifIONS_ & ��,5 SUBMIT:
1. Site PisnJStavey showing the existing str�tms
O Alwninum t] Trim and P�P� Pn!!�-
O Otber ❑ Fascia 2. Txao sNs of caa�struction pl�s
��DOWS 3. Energy Caiculalions
INEXiSTINtiOAElutlNCrS OYts ONo LOCATIQNOFWf13I�WS FORWINDOWS-PRdVtDEUVALiJEAND
OR FOR NEW OPENIIVGS-DESCRIBE SIZE OF MANUFACTURfi STICKF:R ON WIN�W.
OPENING CiiA11GES 8c
TYPE OF WiNDOW TO BE INSTALLED NUMBER OF WIlVD()WS
ALL FEE3 ARE BASED ON VALUATION, INCLUDING THE CUST OF LABOR AND MATERIALS:
TOTAI. d0B VALUATION
Permit Fae
Plan Review
Fire Surchargs
Sarcharge
Licenst Surchsrge
SAC Char�e
Curb Cut Escraw
Bmsion Contral
Park Fee
Sewer Main Charge
E�
TflE 1997 U.B.0 FEE SCHEDULE}
OCCUPANCY
S� Back Page for Fee Scheduie
6$% of Btlildittg Permit Fee
.001 times the wia} job vaivafson
.00QS x Petmit Vatuation Minimum $5.00
$5.00 {State Lice� Residential Gontractors)
$223Q per SAC Unit (Plans to MWCC for determination)
ft+6fi= ftx�25�$
$�50 Consc�vation Plan Review
Fee Determined by Engineering
Agreement necessaiy ( ) Nen Necessary ( )
Make cLscka �vabk to: Cftv of Fridicv Attac
THIS IS AN APPLICATION FOR A PERMIT 1�tOT VALTD UNTiL PROCESSED
i hereby apply for a building p�r�nit and I acknowtedge that the information above is compiete and accurate; that the woric will be in
conformance wiffi the ordinances and codes of the City of Fcidley and with the Mi�nnesota Construction Codes; that I understand �is is not a
�it but anly an applicatioa for a petrnit and cvork is not to start withau# a pennit on site; that the work wil2 be in accordance with the
approvai plan in the case of at! work wh'ch reqtu'iCS ew snd approvat of plans. /
SIGN'ATURE OF APPLICANt',�-���� A" :� PRINT NAME "�/�e�R �� ��J� DATE � OZ� `L
PF.RMfTS ARE REQLTIRE3] FOR PLIJMBiNG, ELBCTRICAL AND MfiCHAAiICAL