P - 36703Building BUILDING perinit �vo.: �
Inspec�ions RESIDENTIAL APPLICATION Re�eive� sy: .
763-572-3604 CITY OF FRIDLEY D �
7E�3-502-$977 FA� EFFECTIVE i-i-ZQI l ������
DA"FE �� � '" l� I �'OUR E-MAIL ADDRESS L�-%(i S �� ���! '" ` � Id� • � r''�'1
s�� �D�ss �l � rtCV ,� �.�V�
THIS APPLICANT iS:
PRUPERTY OVVIVERI
TENANT
CflNTRACTOR
SUBMTI` A COPY OF
YOUR STA`IE LICENSE
AND CER1TFiCATE OF
INSURANCE
FROPERTY TYPE
PERMIT TYPE
.. •
STATE
�coivTxacTOR
%�
��
. �
r:
SINGLE FAMILY/NEW CONSTRUCTTON
TWO FAMII.Y/AiEW COPiS"i'itUCTlOIV
Q ADDTfION O GARAG
❑ BASEI�3ENT FIIVISH �I ROOF
O DECK ❑ SIDtI3G
TYPE OF WORK: ❑ r�w �[01+� CoHS'r[tuc�['tOtv ❑�nrr[�
�O MAINCENANCEIREPAIR 0 REMODII.ING
I�SCRIBE W�iK BEIl�NG DC)I�{E: �" — d�� � a�%�7d
51ZE OF IMPROVIIutFIdT LENGTH WIDTH
� SQUARES �U F� �i � 'j� H�OUSE &�GARAGE
GARAGES � �ATTACHEDGARAGE
PROPOSED SIZE: DETACHED GARAGE
PROPOSID I�ffiGHT:
CEAT NOMBER_� 1
�.vs A
x �.rn �'L.Z� �
tiES
❑ WINDOWS
❑ DRAIN TII.E
I] QTHER
HIIGH'I'
-lU ^
1'i'
� :��.1���_ �::: ��►..� t� ' �i �!
�� � �
, � ;, �
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SIDING FOR NEW CONSTRUC'TiON IlVCLUDINC3 DECK3,
❑ v;�y� � oso�t �-rtorts, � �tc�t� sus�r:
� Alumimim �� � Trim 1. Site PlaNSurvey showing the existing strnclures
and prop�ed project
Other ❑ Fa�cia 2. T�o s�s of oa� pl�s
WIlVIDOw3 3. Enagy Catcuta2ians
W E}f[STIN(" OPIIdINGS DYes @Io LOCATI013 OF WIIVDOWS F�t WIIdDOWS — PROYIDE U-YALUE AIJD
OR FOR NEW OPEN[NGS-DESCRIBE 3IZE OF MANUFACNRE S'f[CKER OlV WtNDOW.
OPENIIIG CHAAIGES &
TYPE OF WIAiDOW TO BE IIYSTALLFA NUMBF7t OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST 0� I.ABOR AND MATERIAI.S:
(USING THE 199'� U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee
Plan R�wiew
Fire Surcharge
��
Lioe� Swr,h�ge
snc c:�
C�rb Cut Escrow
Erasion Conh+nl
Fark Fee
Scvv� Main Charge
$ • -
S �
a
� '
S
S
S
$
$
See Back Page fot F� Schedule
65% of Building Fe.rmit Pee
.001 times the tat�l job vahiation
.oOQS x P+�,it valuua�fit�on A+tinimnm ss.a)
�5.00 (State Li�sed Resider►tial Contractors)
52230 per SAC Urtit (Plans to MWCC fur deter�ninati�)
8+6ft= ftx�25=S
$450 Canseivation Plsn Review
Fee Determined by Engineuing
Agreernent n�arY ( ) lvan Necess�y ( )
iHLS LS AN APPLIL`A1ION F4R A PERiMIIT NOT VALfD i3NTIL PROCESSID
I t�reb�' a�ly for a building permit and I�knowtedge d�at the informatian above is compiete �nd accu�ate; tfiat the work will be in
confonnance with the ordinances aczd codes of the City of Fridfey and with the Minnesota Cazswction Codes; that I u�derstand this is not a
pecmit but a�►ly an applicatios� for a permit and work is not to start without a permit on site; tfiat the work will be in acco�idance with the
approved ptan in the case af ork whi �es iew and approval of p
SIt�iATURE OF APPLICANT .%� -- ��PRINT NAME �� DATE �'I�G�Z� ��
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