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P - 47400Building Inspections 763-572-3604 763-502-4977 FAX DATE lY � �'� SITE ADDRESS THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TY.PE OF WORK: DESCRIBE WORK BEING SIZE OF BUILDING RESIDENTIAL APPLICATION Permit No.: Received By: CITY OF FRIDLEY I Date��e�'a: EFFECTIVE 1 1 20ll YOUR E-MAIL ADDRESS TL�CC/" T-S �!✓���a'' � ��` ❑ OWNER �CSNTRACTOR NAME: ADDRESS:� PHONE: �7Z. NAME: T l.� �. (./� rwvr � s STATE LICENSE # � � Y-fY� �4 � ADDRESS: ��� YOrf� f�1/'Q R�SINGLE FAMILY/NEW CONSTRUCTION O TWO FAMILYMEW CONSTRUCTtON n n nnrrint� ❑ A( ❑ BASEMENT FINISH ❑ DECK ❑ NEW HOME CONSTRUCTION ❑ MAINTENANCE/REPAIR ROOFING �G� NUMBER OF SQUARES [ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other WINDOWS IN EXISTING OPENINGS ❑Yes ONo OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & ^" WINDOW TO BE INSTALLED T ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (U G THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $�• �"� OCCUPANCY TYPE ❑ SIDING ❑ SWIMM[NG POOL ❑ ADDIT. ❑ SE ONLY HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS NUMBER OF WINDOWS CITY ATE/�VI/�ZIP CERT NUMBER CITY �/%�e✓�� STAT&s�?�e'ZIP S_��+�' FAX SLZE STORIES ❑ DRAIN TILE ❑ OTHER HEIGHT FT �°�� BASEMENT REMODELING SUBMIT: L Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans 3. Energy Calculations FOR WINDOWS — PROVIDE U-VALUE AND MANUFACTURE STICKER ON WINDOW. Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ $ $ %� ..1�'� ��, See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $5.00 $5.00 (State Licensed Residential Contractors) $2230 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$25=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks pavable to• City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance 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 d w i o art without a permit on site; that the work will be in accordance with the approved plan in the case of all e' e and PRI�NT NAMEp]an�/'��� ����� �` DATE `O `l� �� SIGNATURE OF APPLICANT APPROVALINSPECTORSIGNATUR �_-___�_ _�.�.-.�:..<..x�Y.,,n�� ,-,r r.r�Tna�,nr .nT:rnxA�'.�'WATT�f'�?;�741('1R� ' �.'