P - 35491i, „. J`v+, VV . vV ,,,v, ,,,, From: 3205938720 v Pa�e: 3/4 vv Date: 1/19/2011 11:06:28 AM��` , V
Suilding BLT�LDiN� ��r�►�c No. c� �
Inspections RES�U�1�'T�A.L �FFLYCATIC)� R�ived �y: '
7b�-57Z��604 Q °d� ' 01
CITY +DF FR���Y ��
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SITE ADDRE.RS ..��c' �7�.S�.Y.�..'�,,.�C ��X� � ���P...I �,� �V � t�� - —
TFIIS APP4ICAN'1' 15• El OWNI:R (AC4N7'RACI'qR
PRUPER'I'Y OWNF.R/ �AML�:
7'ENAIYT ADDRFSS: a, ...C1TY � v�� �\-e�. __�7'A'I'F�[P��� "2..
PH(7NE: � � �---�� �— ��L�
CONI RA4TOR NAME.��„��.�,�4-,'.-!� . �'+�� � � '''"`
S[fHMIT A Cf)PY QF STA'fB LICGNSG #� O��_�i� �i GXP DATG 3-�\-�C'3 �,�,r-,,.,
YQUR $TA'1'� I,TCFNfiF AA(?�tsSS' CITY �,,,; �ci�c1�_ 3TAT�LI1'�
WT77i APPUCATfON PHO O- -�1'�. • F ``
YIiOPLI�'1"Y TYP� 0 SINGL!? PAMILY/NtW CON5Tttl1C'fION 51Zfi
17'!WO FAMLLYMEW CONSTKUCTION S1bR1&S
PERMIT 7'YPE O ADD1TlUN GARAO 'L1SIICD WB
O HASEA�NT FINISH C] ROOF �11G11N TIL,�
O DECK � 9IDIIJG O 0'If1l:(t
O SWIMMMG PC10L
TYP� C1F W'ORKS 0 NCW � ADD TION
C]MAINTF�IAN[•FJRP.DAfR C7kP.MffC1RI..iNC:
DESCRIBE W4ItK BEINC, DpNE:�� �,r. �`�. �� .•. �r:.\tR ^,L�-. �a a.r�c� ��o.yVtie.�c'
SIzE OF'IMPROV�M�T1T LENGTH WNTH Fi�LGH'f . Pt.
HOUSE ONLY
NUMBSROF SQUAR$5��, C) HOUSR �C+ARAGS BASEMPNI_REM2DE1�NCi SUBMIi,
, �x;��;� ruV,r m�,
y� a n�rracE�:u c;�w�,a� Z � flaor pc�
PROP�ED SI�E: L7 DBTACtIP.D GARAQQ �. List of alrucWnl 1d0Tnb0f9 CO 60 usod
PRQPO,SQD NR1GN1'' _
�rIIINC AdR N$W CdNSTRUCTION �fCWDIN(3 D�C�.
C� Vi�+l GSOliil ! DDITII]NS_ PORL'HkiS �llH�
O Aluminum O'1'rim I. Sile P'IeN3iwey ahowing the CxisUt� �tnwyures
O Othcr T,�,,,,,,,, G Pascin ond P��P�d P��JO�•
wINDOWS 4 9'wn xea oPCnMUn�qMm ptrnA
iN g?(lST1NG OPLMNGS pYep QNo 1,qiCA'P�pM p� yy�N1747W8 3. P,n�gy Celpdsdona
QR POit NEW OPI•�fGS-D�SC Wt3L� SI�$ pp _. __
OP�NIN6 CHAN(lIiS & '� �.. _ .... .
TVPE OP WfNTxjW '1'l1 Kt? RN�'I'ALLBU NUMB6� (3F W►I�IpQWS
ALL �'�1�9 AR� �AS�D ON VALUATION, INCI,UDING 7"i�� CO$'�' OR'I�A�OR AND MA'1'�EiIAIS:
Plan R.eview
F�ire Surchsrge
surctmrge
Licease Surchargo
SAC CFrarge
Cutb Cut Escxow
Erxx�ion C'.cmtrol
Park Pee
Scwer Main Chtu�e
U.B.G FEE SCHEDUL�
" �►CCLTPANCY TYPE
$oe Rpck Pase !'or' F'oo Schtdulo
b5%af Building Fcnnit Foc
.0�1 timca thc tot�l jab vafuation
,Od05 x Peimit Vnluation Minimum S.SO
SS,OQ (£tate Licea�sed Residentia! Cantivctor9)
81675 per SAC Unit (Flsns W MWCC for detormination)
it+6R= itxS2]=S
�450 Cpn�ervacion PtaJr Rovibw �
Fee C)eterminqd by EngitloCring
Agreemenc necesrary ( ) Nan Nacessary ( )
M�ke chocks �vable to: Citv of I�ridlev AHac
7'HiS IS AN qPpj,1CA'110N I�OA A PER,MCT-NQ'P YAf�1A U1wfTG PROGFiSSBD
1 hereby apply %r a buiidins permit and I acknowledge that the informntion above ia crnnpiete and accur�te; that the work will ba in
coaformssnce witfi the oMinances artd codes of the Ciry aiFr+dlcy and with tho Min�esofu Cor�struction Codes; that I underetand this is not a
permh but only an Appliostion for u permit and work is not to start with4ut u permi� thst the work wlll be in s�ccorctanCa with the approved
plan in the cait of all which e�yu;re> rGView and spproval of pla�.s. n h
SiGNATURE OF APMLICA ..— ,._ _�11__�. c,� PRINT Nw� ����. l' �...�:� e� ne�rr \1 __. _. 1'e� . r► n t\
���ra�+r°-.�..-.�i r1�' *"n` rr;'��c'�"'C�d
�, ��'��..�,�-
•. ,. . , `�„ Vv. �` , , ,V, ,. , , , From: 3205938720 � Pa�e. 2l4 �v Date: 1119/2011 11:06:27 AM��� , �
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FQUNtiATtON iYSTEM�i INC.
Quality We Can �ua�nuntee
r,�oo-�as8si
nvsx,�,Ar�o�v
n` u� �= ly- �l �
�Ca+eman ��,_,
C :�(� f � � � , � �,Yr� .�1� �' ►-��'t�f t,/ri,v;%�f°� rsz tx : �.. �m ++�.r,,_
! �/
Hpprox�mau numaec or. aays ror �ou cozrtplet�an: �
� ► a � r � � � � 1 " w � � ► � �
Additionel Cbaige for moving
objccts out pf the wo�ic area $„� ��.
Gopher One Amount �f bid $
❑ Yes �( No �us pcmnit fccs ii req�tired
O Homeowner w get pe�mit
C)ur priority is ta fix #ie problem with y�ur fvundasion, that's what our custorners rely on us for. Keep �xu mind that
wc oan aat be res�paa�sible far any finish carpencry, p�inting, pancling, etc. that may be necessary after our work is
completed. Jessc Trebil F�undat�an Systcros, Lnc, will not be respousible f4r any landscapi�ng� resceding or te-soding,
unless otherwise aoted an bid.
WC W1I1 C� "Ciop}acr Ond' ta have all public undcrground liraes locatcd. Xf you have private li�nes such� as sat�llite c�.sh
cabics, propane line� spriNcicr systom� ctc, yo� arc responsible for marking them. Jesse Trcbil Foundatian Systems,
Inc, will not assumc responsYbility if there is damage to private lines. Yf you live at a rura] address, public lines will
ouly be loeated ta rhe gole or yaur pro�erty lin�, if dam$ge ta any of these lines in an area that was not marked
occurs, ypu will be resppnsibl+� fvr ail rep�aus. If your ciCy requires outside. engineering, rhis yuote may need to bo
rewritten to rrecct their recommendatians. Any �dditlongi fees fncurred are not lncluded in thi� bid antl are the
customec's responsib�lity.
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Rept�escntative's Signatu�ra Authorizect Signature