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P - 45773Building Inspections 763-572-3604 DATE ��� �� SITE ADDRESS �0� S I THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERMIT TYPE BUILDING RESIDENTIAL APPLICATION �'� C'11RU � ❑ OWAiER NAME:� CITY OF FRIDLEY Permit No.: Received By: _ YOUR E-MAIL ADDRESS 1�5c�„c�cl@ � epoi� C• C.CJYY'1 . �N �. . ❑CONTRACTOR � ADDRESS: �� � CITY PHONE: ��J� �I�' 07�� NAME: STATE LICENSE #_ ADDRESS: SINGLE F LJ TWO FAMILYMEW ❑ ADDITION ❑ BASEMENT FINISH O DECK TYPE OF WORK: � NEW O MAIN7 DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: Renewal By Andersen 1920 County Road "C" West Roseville, NIN 55113 License #20130983 651-264-4777 _ ❑ ROOF ❑ SIDING ❑ SWIMMING PC O ADDITION AIR O REMODELING ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE Q DETACHED GARAGE ATE ZIP. ATE_ZIP ❑ DRAIN TILE ❑ OTHER WIDTH HEIGHT BASEMENT REMODELING SUBMIT: l. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used Ft. SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl OSoffit ADDITIONS_ & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structure ❑ Other O Fascia and pmposed project. WINDOWS 2. Two sets ofconstruction plans IN EXISTING OPENINGS DYes ❑No LOCAT[ON OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING T 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ Si � �O .00 OCCUPANCY TYPE -- Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Due $ $ �, a� $ a. c� � $ 5,� $ $ $ $ $ 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 Engineering Agreement necessary ( ) Non Necessary ( ) Make c6ecks payable to: City of Fridley Attac6 THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNT[L PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be 'v 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 an ork is not to start without a permit; that the work will be in accordance with the approve� plan in the case of all work whi requires re e and approval of plans. SIGNATURE OF APPLICANT NAME/[1ac�,,,, �1I�S� Y\.� DAT���NLD ��