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P - 41791Building Inspections 763-572-3604 DATE 1 �T �}'� SITE ADDRESS � THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE � ._.���//���c�/� BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY Received By: Date Rec' d: ��`/'/ �l / / YOUR E-MAIL ADDRESS �SQ`��� �°�p��C DC • CC�i(Yl \ ❑ OWNER ADDRESS: � 2 CITY STATE_ZIP PHONE: T10 �°� J a'" � J�� NAME: STATE LICENSE #_ ADDRESS: PHONE ❑ SINGLE FAMILY/NE� Renewal By Andersen 1920 County Road "C" West Roseville, MN 55113 License #20130983 651-264-4777 _ PERMIT TYPE I❑ ADDITION ❑ GARAGE/SHED O BASEMENT FINISH ❑ ROOF O DECK O SID[NG TYPE OF WORK: �� NEW DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT NUMBER OF SQUARES � GAItAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum O Other ADDITiON LENGTH ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE O DETACHED GARAGE OSoffit O Trim ❑ Fascia WINDOWS iN EX[STING OPEMNGS �Yes �No LOCATION OF WINDOWS OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & ATE Z(P ❑ DRA1N 1'[LE ❑ OTHER Ft. RASFMFNT REMODEL.ING SI�MIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, �DITIONS_ & PORCHES SUBMIT: 1. Site Plan/Survey showing the exisdng structure and proposal project. 2. Two sets of const:uMion pians 3. Energy Calculations ' WINDOW TO BE INSTALLED NUMBER OF W[NDOWS I ALL FEES ARE BASED ON VALUATION, INCLUDIIHG THE COST OF LABOR AND MATERIALS: (USING THE 19�7 U_B.0 FEE SCHEDULE) AL JOB V Permit Fee Plan Review Fire Surchazge Surcharge License Surchazge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $ 195� �S $ $ r • $ � , `-�✓ J�—' $ S. O C� $ $ $ $ e $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1550 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engince:ring Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach TH1S IS AN APPLlCAT10N 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 conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not permit but only an application a permit and k is not to start without a permit; that the work will be in accordance with the approve plari in the case of all work whi r ires revie d approval of plans. `� ��� SIGNATURE OF APPLICANT ME DATE �