AF - 46076C�
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Date:
Owner
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City of Fr dley, .
BUILDING PERMIT No s 6 2 7
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Address_..._......._...._..._.._.._...__.._..._._...._.._.....__ ................_...._...._..._......_.._ Address
CA OF B ItDING
No. ���Jn � �
- d •� .. Street ._.. _ .. . . .. ..:._ ._. ....--�'••-� �-�....------.._. P of t ......_.--___.. ....._.. ...._._...._....... . _ .....
Lot ....._. ... Block .----.._..._..� ...•---------• •-------. Addition or Sub-Divisio� ....._. .. : : -----. . .._ . . .. ... ........ ._
...__...._. _.. ..
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Corner Lot ...__......._..._.._._ Inside Lot •---•--. �.......... Setback ..v?--�._....--•--.--- Sideyard ..._.....� �r._:._._'_�.._.:.__.._..._.._..__..._
Sewer Elevatiari _._......_.__..__._...._...__..._.._.._.._..___._ ............._......_ Foundation Elevation
DESCRIPTION OF BUILDING
o v :
/ , _ _. Front _.. �� DePth ��..._.�.._. Height .,r.��.. Sq. F� �,���--Cu. Ft.O'�..!....�i=•-
__.._.._....___.__......_........__..._._ __._.._...._...__ Depth .....__..� Height � .A�Sq. Ft. ._..__._._..._ Cu. Ft _._._..._._
•----_...._..... __
Type of Construction .. ....._.._ ._. . Es� Cost�y�.'""-����.. TTo�be Completed _..._......._..__........_._...__.._._.
In consideration of the issuance to me of a permit to construct the building des bed above, agree to do
th� proposed work in accordance with the description above set fox�h anc�� com ' ce with al�provisions of
ordinanoes of the city of Fridley. . /(i / //
a� -__
Ea camsfderation of the payment of a fee of $.�� �...-.., permit is hereby grauted to.___...._..T
. to construct the building or addition as described above. This permit is granted upon
...__,........_..__......._......._.:......... ._.____.
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon safd building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked a t ax�y time upon violation of a.ny of the provisions of said
OPdiri&i10E8. /") /9 A �l
Bll11�IIg iI18pCCtOT
NOTICE:
'�his p�rmit do�s not wwr th� eonmueNon, installNion for wieiny, phnnbing. 0as h��, aw�r o� wabr. 8� sun to sN
fh� Bvildiep lasp�efor for s�parNe pamhs for fh� itNns.
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APP'LICATION FOR BUILDING PERMIT
CIT1f Ol� FRIDLEY, MINNES4TA '
QSJNET�' S NAME BUILDER
ADDRESS AbDRESS
�
LOCATxON OF BiJILDII�
No. �J �� Street_������ Part of Lot
Lot � Block Addition or Subdivieion
Corner Lot Inside Lot Setback Side Yard
SEWER ELEVATION FOUNDATION BLEVATION
ApplicanC attach to this form ltao Certificates of Survey of Lot and proposed build-
ing location drawn or► these Certificatea.
To be used as;
DESCRIPTION OF BUILDING
Front Depth HeighC
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction: Estimated Cost
To be Completed
�
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances and
rulings of the Departmeat of Buildings, and hereby declares that all the facts and
representations stated ia this application are true and correcC.
DATE � � � GNA ���'���1� �� �
SI TURE s`��-�-- `?%/
� � �� � �
(Schedule of Fee Costs can be found an the Reverse Side).
^ ,, - � 4 . ~ �
Application �or Power Plants and Haerting. Cooling. Yentilation� Refrigeration and
Air Conditioning Systems ond Deviees
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work . . . . . . . . . . . . . . . .. . . . . . . Z.. �r 8.00 $ �(- `
Replacement of Eurnace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.00 �
Repairs & Alteratians—up to $500.00 . . . . . . . . . . . . . . . . . . 5.00 $
Repairs & Alterations each add. �50Q.00 . . . . . . . . . . . . . . . 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,Q00 BTU . . . . . . . . . . . .
each add. 60,000 BTLT .......................
Replacement of E�rnace .............................
Repairs & Alterations—up to $50U.00 . . . . . . . . . . . . . . . . .
Repairs & Alterations each add. $500.00 . . . . . . . . . . . . . .
8.00 $
2.OQ �
5.00 $
5.00 $
2.50 $
STEAM or HOT WATER $Y3TEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam .... . 8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $
Each add. 2U0 sq. ft. EDR, Steam . . . . . . . . . . . . . . . . . . . . . . 2.50 $
Each add. 32U sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . . 2.50 $
OIL BURNER—to 3 gal. per hour . . . . . . . . . . . . . . . . . . . . . . . . 5.00 $
over 3 gal. per hour—See Fee Schedule
GA5 BURNER (up to 400,000 BTU) . . . . . . . . . . . . . . . . . . . . . . 5.00 $
GAS FITTING FEES: NO RATE TOTAL
lst 3 Fixtures ...................... x $1.56 $
Additional Fixtures . ............... x .50 $ -
Gas Range to 200,000 BTU . . . . . . . . . . . x 2.OQ $
AIA CONDITIONI1�iG �
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM $
ALTERATIQNS 8c REPAIRS TOTAL FEE � �—�
ROUGH
FINAL
Depi. of Bldgs. Phone SU i-7470
Location � �� � � 1 � � l C c��• %1�,1 � �
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City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
_ ^ Fridley, Minn. �,�,�c, „ �--G . , 19 ��
Owner � -X �
Kind of Building _
Used as �
To be completed about ��" u��%
[i',etimafnA f!nef � •� � U
Old—New. Building Permit No.
G�''z .
Permit No. "� � �
OF WORK
HEATING or POWEft PLANTS—Steam, Hot Water, Warm Air—No.
Trade Name�,�l Size No.
Capacity Sq. F� E.D.R._�f 6 aG BT[J H.P.
Total Connected Load�a., .� a�-7� 3°` Kind of Fuel �. , y
BURNER — Trade Name Size No.
Capacity Sq, Ft. E.D.R. BTLT H.P.
(REMARKS—OVER)
��<z sM
Signe �
B3'---�,�-r L-� -
Business Phone No.�� ��' � S� S
CIiY OF FRIDLEY
aP?LICATION FQR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITION?NG SYSTEMS AND DEVICES
P�RTI�L �TE SCHEDULE
GR�IVITY WAR��[ AIR:
Furnace Snell & Duct Work
Rep2acement of Furnace
Renairs & Alterations-up to SS00.00
Repairs & Alterations each add. $500.00
�SECHAN I CAL �VAR�I :� 1 R:
FUrnace S'r.ell & Di:ct Work to 100,000 BTU
each add. 50,000 BTU
Replacenent of Furnace
Reoairs & Alterations-uo to $500.00
Repairs & Alterations each add. $500.00
STFr'1h! OR HOT WATER SYSTEAI:
Boi2er & Lines up to 100,000 BTU
each addn. Sii, 000 BTli
Boiler only up La 100,000 BTU
each addn. 50,000 BTL`
OIL BURNER- to 3 yal. per hour
each a3d. 3 gal. per hour
GA� BURNER- from 100,000 BTU to 1>9,999 BTU
(over 199,999 RTU see Fee Schedule)
RATE TOTAL
$12.00 $
7.00 $
7.00 $
4.00 $
$12.00
4.00
7.00
7.00
4.00
$i2.00
4.00
�.eo
6.00
$10.00
10.00
slo.00
Job Address ��~�
Department of Buildings
City of Fridley
Tel. #571-3450
The undersigned hereby makes application for a pernit for th2 work hereiXi
$ Ypecified agreeing to do a:i wo'rk in strict accordance with the City Codes
$ and rulinqs of the Department oE Buil.dings, and hereby declares that all the
$"� UO facts and representations stated in this application are true and correct.
$ % 4 �
a Fri�lep, Minn. / � "� �� . 19� �
.
OWNER ���1 ( � �( � %7
$ KIND Or^ BUILDING '-7 A�/� �^� y
; �
� USED AS ��,�__
$ 'i'O BE COMPLETED ABOUT r v _� a^ ��.
$ �j�/ G9C�
,r, ESTIMATED COST `%�
�%b °� OLD t7EW BUILDING PERMIT NO. PERMIT NO. _�� `�-�
$
GAS FITTING FFL'-S:
lst 3 Pixtures � a� 3•�� $�'� U
Additional Fixtures x $ 1.00 $�
Gas Range to 199,000 BTU x$10.00 $ _
�IR CONDITIONING �� S
FAN HEATIVG SYSTE�IS r See Fee scnedule $
VENTILATING SYSTEMS S
ALTEF2�;TI0;�'S $ REPAIRS ,) S_
- State Surcharge $ .50
TOTAL F'EE � e�O . S,2i
RUUGH INSP
Date
FINAL INSP.�-/ -
Date
APPROVAL FOR PERMIT < FD
REINSPECTION FEE
(_$10. 00)
MINIMUM FEE r^OR ANY HEATZNG PE.T2MIT IS $7.50
DESCRIPTIO?�7 OF FURIJAC°/BURNER
HEATING or POWER PLANTS, Steam, Hot Water Warm Air- No.�
Trade Name Size No.�� ,
Capacity Sq. E' . EDR _ BTU xP
Total Connected Load Rfnd of Fue1 ��
C!
BURNER - Trade Name Size No. _������
CapaCity Sq. Ft. EDR BTU _ HP
Company . �L�/ �� �.LC.t� �' � 'I��' l•r�w�
Siqned By ��4 -�-
` ��.r �.
Tel. No. �,��� � � 7 �
SUBJECT
City of Fridley 2 5 31 0
AT THE TOP OF THE TWINS g � I L D I N G P E R M i T
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COMMUNITY DEVELOPMENT DIV. ��� ��
V PROTECTIVE INSPECTION SEC.
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i.---�; /'��;'� CITY HALL FRIDLE� 55432 NUMBER REV OATE GAGE OF APPROVEO 8V
� 612-571-3450 9�0-F15 7/24/97 � �
JOB ADDRESS 752�_29 Able Street NE
t LEGAL LOT NO. BIOCK TRACT OFi ADOITION SEE ATTACNED
DESCR. ( 2 Nagel's Woodlands SHEET
2 PFOPERTY OWNER MAIL ADOfiESS ZIP PHONE
ABLE PROPERTY MANAGEMENT 9920 Zilla St NW, Coon Ra ids Mn 55433 754-0743
3 CONTRACTOR MAIL ADORESS ZIP PHONE LICENSE NO
Kozitza Construction 9175 Isanti St Blaine MN 55449 786-3625 2650
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE UCENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PMONE LICENSE NO.
6 USE OF BUILDING
Du lex
7 CLASS OF WORK
❑ NEW O ADDITION O ALTERATION O REPAIR ❑ MOVE O REMOVE
X
8 DESCRIBE WORK
Construct a 22' x 22' Detached Gara e
9 CHANGE OF USE FROM TO
STIPUTATIONS
See notations on plan. Provide a hard surface driveway.
Variance on rear yard setback approved by Appeals Commission on 8/14/96.
� ������
eefore digg►�B �a�� for
$EPARATE PERMITS REQUtRED FOR all util�ty localions
WIRING, HEA7ING, PLUMBING AND SIGNS, �� �2
R�QUIRED BY LAV1�
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NUIL AND VOIO IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAVS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINEO THIS APPLICATION Z STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SUHTAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIEO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �8,949 ��F.�FJ
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING cor,- �149.75 Fire SC �H.95
STRUCTION OR THE PERfORMANCE OF CONSTRUCTION.
C� � PLAN CHECK FEE TOTA� FEE
License SC $5.00 $168.17
5iG ATUAEOFCON'RACTOFlORAUTHOA�ZEDA ENT �DarEi WHEN PROPERI ALID ED THIS IS VOUR PERMIT
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SiGNATUFlE OF QWNEA i�F OWNER BU�LOEAI IDATE� Bl �NS� �1�TE
i\� E�V��
AllDN
ALTI�IZ
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ConstcuctionAddress: �
Legal Description: L,
Owner Name & Address:
Contractor:
Address: �� : i
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
CI'I'Y OF E RIDLCY
SINGL� FAMILY ANU DL�PLEXES R-1 AhTD R-2
BUILDING PEIZNfIT APPLICATION
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Tel_ # 75'y- �7�l3
�= MN LICENSE #
����� Tel. # ��Y�G'2�t 3
Attach to this application, a Certificate of Survey �f �
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
�n� Width Height Sq. Ft.
Length �2 `�. Width a a Height Sq. Ft. Y��
�ng� Width Hgt/Ground Sq. Ft.
Construction Type: �l� �,�zQ � fY,�,,,,.� Estimated Cost: $ �(�Dc� <<��� ,.s�e�_ , I
(Fee Schedule on Back�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft �x $ —$
DATE: 7 - � �
Permit Fee
Fi.re Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Se�ver Main Cllar-ge
"1'( )' I'n I ,
ti f�il'( I(.;�'l�i( �Nti:
A.PPLICANT: � �' ';�,� Tel. #�7 ;� Y� c5 ? Y 3
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CITY USE ONLY
$ f �/�� % Fee Schedule on Reverse Side
� . � .001 of Permit Valuation (1/lOth%)
� � �% $.50/$1,000 Valuation
$ $950 per SAC Unit
$ L � $5.00 (State Licensed Residential Contractors)
� Alt. "A" or Alt. "B" Above
� $450.00 Conservation Plan Review
� Fee Deterinined by rngineering
� Agreemenl Necessary [ ] Not Necessary [ ]
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sue�ecr RMIT NO.
City of Fridley 2 6 79 6
AT THE TOP OF THE TWINS g � i L D I N G P E R M I T
r
� ` RECEIPT NO.
� • COMMUNITY DEVELOPMENT OIV. ,� / e� .
r � L � PROTECTIVE INSPECTION SEC. `� � J
� . �
� � �"'1 � CITY HAIL FRIDLE� 55432 NUMBER REV OATE PAGE OF AGVROVED BY
�.---� • •'' 612-571-3450 9t0-Ft5 7/23/98 � �
JOB ADDRESS
7527-29 Able St NE
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACMED
DESCR. 6 2 Na el� SHEET
2 PROPEiiTY OWNER MAIL ADDRESS ZIP PHONE
Able Pro M mt 754-0743
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Owner
4 ARCHITECT OF DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PHONE IICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION �7 REPAIR O MOVE ❑ REMOVE
6 DESCRIBE WORK
Reroof 22 S Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must complywith State Building Code.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV lOAO
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING.
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID If WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCEO WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERI00 OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV TNAT I HAVE READ AND EXAMINED THIS APPlICA710N 2 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GiiANTING OF A PEFMIT $1834. HO �. 92
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANV OT STATE OR LOCAL LAW REGULATING CON-
S7RU ON OR THE ORM CE OF , ONSTRUCTION �59. SO Fire SC � 1. H3
�` PLAN CHECKFEE TOTALFEE
License SC $5.00 $67.25
StGNATURE OF CONTRACTOR OR AUTHORIZED AGENT iDArE� WHEN PROPERLY V DATED THIS IS YOUR PERMIT
. W � C` _ / •_-
SiGNATURE Of OWNEA UF OWNEA BU4DEAi iOATE� BIOG �NSP p�TE
NEW
ADDN
ALTER
�)
Il
�)
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: ��� `� �-- v� j� �Q � L �S � /��� •
L,egal Description:
Effective 1/1/98
�v a�
���
Owner Name & Address: d�,�!3�, C r��-G�� ���i1.1�, Tel. #
Contractor: ��/t'� MN LICENSE #
Address: Q � ? O `Z % �- �7� i �C�� ������._S' � Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale. �
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction Type:
Length
Length
Length
Driveway Cu.rb Cut Width Needed
DATE:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
,
DESCRIP'TION OF Il�IPROVEMENT
APPLICANT:
$ ,��
$ `�F3
$ . ��
$
$ �
$
$
$
$
� Z�
� .
Width
Width
Width
Height Sq. Ft.
Height 5q. Ft.
Hgt/Ground Sq. Ft.
`
�- ��-
Estunated Cost: $ iC,S 13��
(Fee Schedule on Back)
Ft. + 6 Ft = Ft x$ _$
Tel. #
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1 / l Oth %)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
, , . y.
CITY OF FRIDLEY PERMIT o.: 2004-012�
6431 UNIVERSITY AVENUE NE ___-�
FRIDLEY, MN 55432 DATE ISSUED: 08/06/2004
�631572-3604 FAX: (7631571-1287
ADDRESS : 7529 ABLE ST NE
PIN : 123024220023
LEGAL DESC : NAGELS WOODLANDS
: LOT 6 BLOCK 2
PERMIT TYPE : BUILDING
PROPERTY TYPE : DUPLEXES
CONSTRUCTION TYPE : WINDOW/DOOR REPL
VALUATION : $ 1,500.00
NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DUPLEX PER R317 OF
THE 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS.
INSTALL AN EGRESS WINDOW. PERMITS REQUIRED FOR BASEMENTBEDROOM FINISH.
STATE LICENSED CONTRACTOR 1
APPLICANT
TRENDY ROOFING SONS INC (20027543)
210 ZACHARY LANE
PLYMOUTH, MN 55441-
OWNER
ASHRAF LLC
2947 BENT TREE HILL RD
NEW BRIGHTON, MN 55112
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
vioIate or canc t�e provisions of any other state or local law
regulat' erformance of cons cti n.
Ap ca Date
Bldg Insp � Date �
BUILDING PERMIT FEE
FIRE SURCHARGE
STATE SURCHARGE, VALUE
LICENSE SURCHARGE
TOTAL
SEPARATE PERMITS REQUIRED FG�: WORK OTHER THAN DESCRIBED ABOVE.
54.00
1.50
0.75
5.00
61.25
N� � � CITY OF FRIDLEY
ADDN [) 6431 University Ave NE, Fridiey, MN 55432
ALTER [] SINGLE FAMILY AND DUPLEXES R•1 AND R-2
BUILDING PERMIT APPLICATION
�
Construction Address: �
Legal Description:
Owner Name & Address:
Contractor. � � �'`n�'
LIVING AREA:
GARAGE AREA:
DECK AREA:
,. �7 S ��
Effective 4/1/2004
(763) 5T2-3604 Bidg insp
(763) 571-1287 Fax
�,.��C;�� K (`�1�%
� ��_-� �!' Q �,,.
� Tel.
�C 1
MN LICENSE #
�``j�Tel. #�l-�3 5�,1 �q�-'13�3
Attach to this application, a Certificate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length _ Width Height Sq. Ft.
Length Width " Height _ Sq. Ft.
Length Width HgUGround Sq. F�
ATHER:
.5�.� ,��.
Construction Type: � � "' ��'� Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE:� ^ ^
L� APPLICANT: � T�'��= ��_l�
Call (763) 572-3604 for Pertnit Fees if mailing in application. Fax to 763-571-128 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge ,
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
�,�
$ ,�y C.�
$ `—.-'
$ � S C?
$ �S�
$
$ S -C�C�
$
$
$
$
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
.,
$ - �- �?S
cn
STIPULATIONS:
�
_ _ ____ _
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