AF - 36500sua�ecr PERMIT NO.
City of Fridley � 15 3 7 7
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
r
; � RECEIPT NO.�
� • COMMUNITY DEVELOPMENT DIV. Q� � 6�
�
� '-"'-�
r � � PROTECTIVE INSPECTION SEC. � � �
1 �
� � /'�'1 � CITY HALI FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BV
� ----'�-• •�� 612-571-3450 910-F15 g���'79 / /
JOB ADDRESS 1639 Brenner Pass N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2 1 Innsbruck North Townhouse Plat S SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Darrel A. Farr Developqnent 7286 - 72nd Lane, Brooklyn Park, MN 55428
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Same 560-8110
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Res idential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
X
8 DESCRIBE WORK
Construct an 18' x 28' Townhouse (D Unit)
9 CHANGEOFUSEFROM TO
STIPULATIONS party wall must be two separate 1 hour wralls from bottom to roof.
Firestop soffits. Provide combustion air for furnace from outside.
WARNtA1�
SEPERAT� AERMiTS REQU►t�E� �OR y� 8efore digp� tEC!' fo�c.�� util,7ies
TflE�NpNE .
iiEATING. PLUMeING AN� SIGry$. �G' REQt�fRE ��.�£�.
D By L�y,�
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOC� FY3IRE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. fT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OA ABANDONED FOR A PERIOD OF 120 DAYS AT 1440 13,248
ANY TIME AFTEA WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTiNG OF A PERMIT 26 300 S�-3. 1-S
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY TH ST TE OR LOCAL LAW REGULATING CON-
STRUCTION TH ERF RM � CE OF CONSTRUCTION. �j2�99 425.00
�_ �` � _ PLAN CHECKFEE TOTALFEE
�� � � '" � 4 39
" SiGNn7uaE0 0 70a0 THORIZEDAGEN7 �Dn7E� � W EN PRO E L IOA D THIS IS VOUR PERMIT
_ ,L L � ��-)5,
SIGNa7URE OF OWNERUF OWNER BUILDERi iDATE� B�DG �tiSP ��FTE
° L! 1 T Ul� 1�1�1111 LI ..
. • �
, a s' .
.° !►I'PL.IChT1Ui1 fdR IZI�STI)FId'f1�L P.U11_DIl�lG f f:Itf�iI7S .. �
� ° . (i�J�:tir, ni_1'L'ft/171U(d5, nl?llIT10iJ�, OR R,L'PAIRS) "
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. , . . _
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ot;cirn: _ •Cl . �'�- �Qv-��,�a ruxr.u>>>z: �L'��--�.,� . -
. .
%iCi(iY.(•:;:;: 7��� �%%. rf��G� �'�7K�i •/:��YCJJ: � .
��--��ir �� %�55 � � Tc�.. 1•:0 . : �� � ' �-// d .
�/
):v. : l � 3 9 Strcet : /��.�-w,c�e�c' ��.t� • ` • .
7.OT: � }3LOCY.: / .nbDx7`x0;�: S �' � ' ' �
CO�tti}iit L�J'1': IIJSXll� IAT: ^�_ S,^:'T}371CY.: . Sxll1:YA12D�: '
Ap;�lica'r,L- attach �.o this foxm R��� Ceri:ifi.catcs oi Survey of_ Lo.L- and pr.oposed
bui2�cling �oc�tian clra�an on these Certificai:es. . �
- o . .. •
. .` .DESCRTPTIOI�d OF BUILDII�G • �:..u��z'� -
'�Co l3c Used As: ' - - � � . . - . . • . . . � ' -
• Txont: j� Depih: : o? �� l3ea.gh�t-: 0�8 '- -
• . . . Square Feet: /�S�O cub�c Feet: /3. a �/� w . '
- .. •I'xont: • - Depthc.. • lle�ght: - .
Squar.e reet: . Cu2��c Feet: . . _
�
_x'ypL oi Construction: G�J G-� s� --f �--7-Yt..��-----T �timated Cos�: $ a� ��i9�
.
5tb I3e Comnleted: 0�-b--ri- rl � � -, . � Isli. A Alt. B
' Pxoposed Drive�aay t�,idtii 7f Ne�a Opening xs Desired $ S
• � � (srr•. �:�V�I'•SE SID7; OF SHL•'�T)
x'i2e undcrsigned hereLy makes ap�lication foz � pexmit io� the �oor): herein �
specii5.ed, �zr,i�e�_ng to do all �:or.}: in stricL acc��_dance t•�i.th tlie Ci.ty oi .
kr.�dtcy Ordiiiances and rul.i.i�gs of the Dc??atL7�enL.of l�uildi�lgs, i211C� ilC2"C}�}r -
c?ec).azes Lh� ��z.11 ihe facts and �epresent.ai:ions stated in i:his �-�pplicat��on
a�:e txue vid cor.rect-. �See zevc�_se side f�r �lcldition�l xnLornz�zi:ion. -_
. . ' ♦
De�'i'�: �f L� � �f SXGNII'1'UJ:I:: � -- _
Y
${��}�ll�_.7LIO11S' . , -
�
� ��99 '` - . .
��. a5 � � Ctl�c� - _ .
l �. �� Su�2��`?G �. �
e '`��.�, �� � • . - '
�' �o`� ��1 � . ' _ . , . � .
• . � �y �/�9 �� y,. 3 �
HOUSE HEATING TEST RECORD
ADDRESS � APT. FLOOR CITY UBURB
OCCUPANT � .��,, � l'iZEl.1'� OWNER �� ��[ -r�f
HEAT LO55 U DATE HTG. INST.
SOLD BY INSTALLED BY �n��p
Eleetrical Work By � Gas Line By ���n¢'
TYPE OF HEAT GA FA �CHW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE ��� MAKE OF BURNER
Model � .F ( 2� Ti'� /�•�I� Modsl
Ssrial Max. BTU Rating
INPUT `1�T�tX� MAKE OF FURNACE
Model
T </ �CONTROLS J
THERMOSTAT �L Heat Plug ���� Vent Size
Valve �A?� KIND OF LINER L' SIZE NONE
Limit �--y�� Draft Hood '" Ragularor
Limit Setting ��� Filtsrs Size Number
Fan Setting � Chimney Location Inside
�� Outside
Pilot Type Chimney Construction
Pilot Make
Pilot Model — Smoke Bomb Wiring ✓
Pilot Timing j' �� �t��� Drcft D{�„� Tsst Tay ��
L.W. Cut Off Door Pressure Lightiny Inst. �
Prossure -� 5 Percent CO2 � Date Tested
Input CFH ��5 Percent 0 Company Testing '
2
$tack Temp. ���---Percent CO _�.) Name oi Tester
Form 235
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND NEATING, COOLING, VENT:LATION, REFRIGERATION ANA
AIR CONDITIONING $YSTEMS AND DEVICES
PARTIAL �TE SCHEDULE
GR,IVITY iti'.�iR�i AIR:
Fti �ace Shell s Duct Work
' P.e�lacer. _nt of F1irr.ace
Repairs & :+ltc.rations-up to SSQ0.00
Repairs & Alterations each add. $500.00
ASzCFif�\`IC�L StiAR�I ,1IR:
itir�ace S::ell & C�ct Work to 100,000 BT[I
ea.h add. 50,C00 BTU
'P.�p2ace��:t of Fu:nace
?.e:airs & AiteratioZS-up to $500.00
aee��irs & F,lterstions each add. $SOQ,O�
s�a:�t o� Fi�r P:aTE.R SYST�f:
3oiler s Lines L? to 100,000 B�IJ
each ad:n. SC,000 B:U
Boiler o::ly u� to 100,000 BTU
eacn adza. 50,000 BTU
OIL EUR\rR- to 3 gal. per hour
� cac:� afld. 3 gal. per hour
W1T �
�i2,00
�,00
7.00
4.00
$12.00
4.00
7.00
7,00
g,00
TOTAI,
6
�
�
�
S 1 r;
S
$
$
6
�
$12.00 $
4.00 $
7.QQ $
�•AA 5
Siq.AR
• �R�Rq
G.aS BURXER- fro� loo,000 sz-,r �0 1�9,��� ��p
(over 1�?,999 BTU see Fee Sche�ule�
GAS F?TTI::C, FE'cS:
ls*_ 3 Fix tuzes �
;:�3i:iozal Fixtures
Gas Pazse to 199�qOq ��IJ
,�IR CO�DITIO\ING
Fa\' HE.�TI\G SYSTE�fS See Fee schedule
V°�TIL� 'G '`
s�P�aA
x $ �•AA
X $ �:AA
� ��A:AQ
... . TI� SYSTL•,•3S
AL.ER'rTIO\S F� REPAIRS
State Suzcharge
• TOTAL FEE
Ft�JuGd INS?.
� Date
F22iAL I2+S?. / 2- Z. Z= YU
I3aC3 ,
AP?ROVAL FOrZ PER�:IT I��
REINSPEGT20N FEE
iS10. 00)
S
S
$ .� _ �
, . � ``
5
$ '�
S
S
�
S
$
S
$ .50
$ .;- -�c�
YS2.'IN.�:: FE^c FOR A2r"Y HFATING PERN.iT IS S7.50 PLUS $.50 STATE SURCfiARGE
•:.ttac`.e3 stack vezifiea;,�on fora •
0
�ob Address '
�/,'.:; :, ���I'l; r �l),l, t i i�('. �L
�
Aepartment of Bu��d�ng9
C}ty of Fzidley
� Tel. #571-3450
The undersigned hereby makes application for a permi.t for t:e :+or;c here�
! specified agreeing to do all work in strict accorcance with t'r.e City Cczes -
and rulings of the Depart^.tent of Buildinqs, and 'nereby ceclares t^.at a:l t:.e
Pdcts and z'epxesentdtions stated in this application are t_-i:e ard correct.
F�idley� Minn. , 19_
OWNER iJ r _ � rC �,� ' ; ;: � i_ j � • •
�CIND pF SUILDII�G " �. t
ps�p As � � �x. � ' f
�A �� FQr7�L�T�R AgRK�
�5��?��R �RS� � , :,� �� ` � ,.
. �-� ,
P�R ' ��W �A��A�F�G ���"?�� NO. P�R�1�T 2:0. ' /��. !
�ES�R�P�'ZON QF FUR^1ACE/�RUR�ER
#i�T�NG a� �AF�R ��'!N�'S{ Ste�-'�i #ta� Y?az��, Wa,r.�1 A}�- No.
Tx'ad� Name � r�' C'I P, _�_ S�ze No.
CaPdci.Cy S4• Ft. EAA 8TU ��-', L i(. i�
7bta1 Connected Load Kind of Fuel
BURIvER - Trada Nama Size No.
Capacity Sq. Ft. EDR BTU H?
�
e
1
Company � I E �-� :r,
- i ��
Siqned By � L ��
Tel. No. "�<`i, i`�,`L=iC _
9� - �, -1,16051
CITY OF FRIDLEY
A?PLICATION FOR P(1.��3ING P11�A uAS FITTING pEr?MIT
i
M I >, u: 'y u • X a� Water
q a+ c s� •�+ ,1 -� b�
�- n a � N c• ;n q +� u+ fieateT
;,� i+ .a r E. .-+ h � N ro s. ti. r�
-.. •.. n _' � n x u o u s c � c� �C wy �
p :� C -+ =+ ( c c c� ..�i -��i � o � v�a � U N N m x
o: r U� � cl e� u-+i 3� yI uti r~.. Uw �3 � '.�. � o as 'le
=�=i I j � �
_ :� � I
�::;; ����-
�_.I i ( I I I !
(�) = r^,:tsre Co::nec:iol 0: e^ir.g
(*i = 2:ew Fix�:re, pld Ope�inq
Cotuiected with
PAP,TIAL RATE SCHEDULE
?LiJ�3I\G FIXTURL R,1TES: A'0. RATE
S_�er Fi�t,.res x S3.Q0
:..:�e . �xt..se C�er.:r.4 x $2.00
2:e+ Fix:::re, Old Openinq x SZ.00
Catc': 33sia x $5.00
:�atez =eater - Lo 99,000 BTU x $5.00
-��, 0�� n:J to 199.000 B'i^I7 x$10.00
Ha:er So_ter.er x $7.00
�ev Grou:d :.:a Old Suilding x $5.00
Electric hater Y.eater x $5.00
G�S FITTIXG FE:.S:
ls� 3 :?xtures x $3,00
a3.'.itioaa2 Fix tures x 51.00
Gaa R::.ge ;.0 199,00� STU x S3:0.00
�?�:�S � AL:EnATIO\S
c^izs: 5100.00 SS.OQ
eac:: add. Si00.00 or fraction $2.00
State Surcharqe
TOTAL FEE
REZ26SPECTZON FEE
($10.0�)
Sewer
Water
TOTAL
S
$
$
S
$
S
$
S
S
S
S
S
S
$ ,50
S O O
Job Address 1b39 Brenner Pass
Depzrt-�ent of Euildings
City uf Priflley
Tel. #:i71-3450
The undersi.gned hereby nakes apolicatioa for a pe^it for the work ::eze?.z
speeif.ied agreeing to do all woric in str±et accorflance w?th t5e City Co�es
and rulings of thQ Depart:.ent of Buildir.9s, and `,ereSy �ec! ares t:.a;. aIl
t}�e fact•s aiid reprosontations stated in t�is applicntion azc Cruc ar.d ocrrxt
Fridley, Mn. 12-23'�0 , 19
o�N�R DARRELL FARR
XIND OF BUII.DZNG frame
us� As 12-30-80
TO BE COMPLE:ED ABOUT
ESTIMAT�D COST
OLD - NEW SUILDING PE�Z`:2T h0. PcR:4ZT 2h0. �'Lf 9�
�C.,,,%6sg4 �' ��� r- �.
Company �� o- o - "'-r�r„�;;�
fvi1R��:rA�<:
Signed By
Tel. No.
ROUGIi INSP.
Date
FI2SAL ZNS2. 1 -/ � ';�,�
Date
APPROVAL FOA PER�iIT ��
MINIMUM FEE FOR TiNY PLUN.BIISG Pc^R4IT ZS $7.50 pLUS $.SO STnTE SUrZC3�1rZ.r'„
sua�ecT PERMIT NO.
City of Fridley ,�
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T r� M' !W� �' �
f
� � RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV.
' � - """, � �
r � � � PROTECTIVE INSPECTION SEC
i �
� . , _
� � �"'1 � CITY HALL FRIDLEV 55a32 NUMBER REV DATE PnGE OF nPPFOVED Bv
�""�"� ,�' 612-571-3450 9�0-F�5 � �
J08 ADDRESS 1639 Brenner Pass NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 9 1 Innsbruck North Townhosue Plat 5 SHEET
2 PROPERTV OWNER MAIL ADDRESS ZIP PHONE
3 CONTRACTOR MAIL ADDRESS ZIP PMONE LICENSE NO
Gittleman Construction Corp 7900 Xerxes Ave, Bloomington MN 55431 571-1023
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS ZIP PHONE IICENSE NO
6 USE OF BUILDING
Residential Townhouse
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION C� REPAIR � MOVE ❑ REMOVE
B DESCRIBE WORK
Deck Repairs
9 CHANGE OF USE FROM TO
STIPULATIONS
Deck construction including handrail, guardrail, spacing, etc. must comply with the
State Building Code.
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCYLOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTFICAL, PLUMBING, HEATING,
VENTILATING OA AIF CONDITIONING
THIS PERMIT BECOMES NULI AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OF IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ], STALLS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPL.IED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �2%O.00 �.SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRU TION OR THE PERFORMANCE OF CONSTRUCTION �IS.00 Fire SC �.27
i PLAN CHECK FEE TOTAL FEE
'�`; i�� $15 . 7 7
SiGn+ar aEOFCOn�ranCrOROanuTHOaiZEDnGEn+T iDnTE� WHEN PqOPERLY LIDATED THIS IS YOUR PERMIT
_ uv, �_ q �i�' -
S�GNaTUAE OF OWNEA i�F OWNEA BUiLDEAi �DATEi BIDG � 5� r�p7E
NEW
ADDN
ALTER
[l
Ll
[l
CITY OF FRIDLEY
SiNG?�E FAMILY AND DUFLP.XES R-1 AND R-2
BUilding Permit Applic;ation
Construclion Address: ���G� �(2.t►•..) r�-) � i2 1-'�a>
Effective l / i /94
��7��
L,egal De�criPticn: �
,c>.ssr� c.
Owner Tta�ne& AdcL�ess: I►�►�.15B2uGK NOtZ7!-� 7�v.lt�lNOt�S�. Te►• �f 831 ZSoS
Contractor: C i-f-TL� �,�►A ►�-1 cor�ls-T fz-UG-t-I c. r.l Go 2-P MN LICENSE #
Address: jr7� �� 1l� k? XE S.��I � �3Loo r��l I nl Ca�Ot�-1 �� 3,Z Tel. #�i I� I O 23
LIVIIdG AREA:
GARAGE AR�A:
DCCI� ARLA:
OTIiER:
Attach to th�s aPplicalion, a CerliGcate of Survey of the
lot, witt� the proposecl construction drawn on it to scale.
.Length
I.englh
Length
B�SCRIPTIQN OF IMPROVEMCNT
Width
W idlh
Width
Heaght
I-ieight
Iigt/Gr.ound
s�. rc.
St�. Ft.
Sq. Ft.
Corner Lol [] Inside Lot [] Ft. Yd Setback Side Ya.rd Setbacks
Type of Construcdon: D���C.. �,p�� 2S Estin�ateci Cost: $_� �" �Z7a P�i7�`,�
Apprax. Completion Date: I v- 3 �- 9�{-
(Cos� o�� Back J
Driveway Curb Cut Wi:�th Needed: Pt. + G�t = Pt x$ _$
DA'fL: °�-1- ���' �� APF�LICANT: � ��- Tel. # �/I -IoZ 3 -
Fermit Fee
rire Surcl�arge
Slalc Surcliarge
SAC Charge
License Si�rc(iarge
Uriveway Cscrow
Lrosicm Con�-ol
Park Fee
Sewer Main Charge
TO"TA L
STIPULA"I'IONS:
$
$
$
$_
$
$
$
$_
$
�
��.�iiL����7�i�
Fee Sct�eclule on lteverse Side
.Q01 of Per�nil Valualiott (l/101ti%)
$.50/$1,()j)0 Valuation
$$00 per SAC Unit
$5.(}0 (State Licensed Resiclen�ial Contraciors)
Alt. „A° or Alt. "B" Abc�ve
$450.(� Conservation Plan Review
Pee Determinul_ hy Engincering
Agreement Necessary ( � Nc�t Necessary O
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SuB�ECT •
C;ty of Fridley 3 0
AT THE TOP OF TME TWINS g � I L D I N G P E R M I T
i � RECEIPT NO.
� �
� ' COMMUNITY DEVELOPMENT DIV. �D� 9
� � �: ----- �
r � �� pROTECTIVE INSPECTION SEC.
� _ �"'1 � CITY MA�I FRIDIE� SS�32 NUMBER REV D�TE P�GE Of •PPROvEO er
�""'�" �'' 612-571-3450 9t0-F15 6/27/00 � �
J08 ADDRESS 1633,35,37,39,41,43 Brenner Pass
t LEGAI LOT NO. BLOCK TRACT OR AO�ITION SEE AT7ACHED
DESCR. —6 � 7-12 1 Innsbruck North Townhouse Plat S SHEET
� PROPER7Y OWNER MAIL AOORESS ZIP PHONE
Innsbruck Townhome Association 651-224-5482
J CONTRACTOR MAII ADORESS ZIP PHONE IICENSE NO
Garlock-French Roofing corp, 2301 E. 25th St., Mpls., I�Il�i 55406 612-722-7129 0000142
� ARCHITECT OR OESIGNER MAIL ADDRESS ZIP PMONE �ICENSE NO.
5 ENGINEER MAIL ADDRESS IIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CIASS OF WORK
O NEW O ADDITION ❑ ALTERATION � REPAIR O. MOVE O REMOVE
8 OESCRIBE WOfiK
Reroof Townhouse Building (Tear off)
9 CHANGE OF USE fROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
�ermit Inspection Cards
Wiil Bs Matled
To Hameowner To Past
1YPEOFCONST. OCCUPANCVGROUP OCCUPANCYlOAO
SEPARATE PERMITS ARE fiE0U1RE0 FOR ELECTRICAL, PLUMBING, HEA7ING,
VENTILATING OR AIR CONOITIONING
TMIS PERMIT BECOMES NULL AND VOID IF WORK OR CONS7RUCTION ZpNING SO. fT CU FT.
AUTHORIZED IS NOT COMMENCEO WITMIN 60 DAVS. Oii li CONSTRUCTION
0:1 WORK IS SUSPENDEO OR ABANDONEO FOFi A PERIOD OF 120 DAVS AT
ANV TIME AFTER WOFiK IS COMMENCED. NO DWIG. UNITS OFFSTFEET PARKING
I HEREBV CERTIFY THAT I MAVE FEAO AND EXAMINEO THIS APPLICATION 6 STA�LS GAiiAGES
AND KNOW TME SAME TO BE TRUE AND CORRECi. All PROVISIONS OF LAWS VA�UATION SURTAX
ANO ORpINANCES GOVERNING THIS TVPE Of WORK WILL BE COMPLIEO $21 194.%S �lO.SS
WITM WMETMER SPECIfIEO HEREIN Op NOT. THE GRANTING OF A PERMIT �
DOES NOT PRESUME TO GIVE AUTMORITY TO ��OIATE OR CANCEL THE pEqMIT FEE SAC CMARGE
PROVISIONS OF ANV OTHER $TATE OF LOCAL LAW REGUTATING coN- �349. ZrJ Fire .SC �21. 19
STRUCTION OR TME PERFORMANCE Of CONSTiiUCTION
PLAN GMECK FEE TOTAL F
$38 . 3
S�GN�TUpEO�CON"A1CTOpOpAUTMOa�2ED�GENT �D�iE� EN F1OP AL�OAT D �S IS Y UR PERMIT y
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S�GH�TUpE Oa OwtiEQ��� O�NNEA BWIDEA� �O�TE� „�NS� r�e.rt