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P - 46802�Vi1-tl-ir i�+:�ru From: HameSure Page: 3/5 n�urCaui�G �ate: 11/17/2011 2:22:42 PM ic� +• �ro�� auc-�+Y�u r aia �uildi�:g B�1Y��;�NG Inspc��iqns RESII���'r'IAL ��'�'LIC'ATI�I'�i ���-s72-��0� CI'Y'Y +D�' FR,iDL�Y 7G3-S02-497� FAX cr���rrvc i-c-��, � SfTF ADDRE55 �{! � Ti�IaB E4F'PLIC.ANT 1S; TENANT SU[3MIT A COrv Or YOUIt 5TATE LICENS� AND CERTIFICATE C1[' 1NSURANCE PIiQP�RTY TYPE PERMIT TYPE D6SCFifQB WURh YQUR E•MA[L ADDRE55 � QWNER '�CONTRACTOR NAME;_ _ �� ADQRC;iS: �}±���Q�rS�O� ��`, rrtorr�:��3=..��� � '��.p� . NAME; �� � '���[�j� f�",� �s'TATE LiCCNSE ft�����y ADDRESS� p�p����� (, Pt•IDNE �D�a�r � � �Q '�1NGLE FAMILY/N�W GI�NSTRUCTiON CI TWO fAMILYMGW CONSTRUCTION O ADUI'CIUN O CARAG ❑ BASEMENT FlhilS7•F p R()()(' 0 ��c� p stnir�c O SWiMM � NE�Vi•lOh1E CONSTRUCTI�TI C] MAtNTGNANCE/RCPAIR B� rrir NUMDGR Of SQUARES ,� PROPPS�D ti1�E. J'RQPQSEP 11EIGIiT; SiDt ' � o vi„yl � Alumii�am Cl OIheY Wt r�tiWw IN E}CISTINC t7PBN1NGS CIYch �No QEi fQ� TEW 4RL•N[NGS-D�tiCR1a� Sl'LG UR O�CNING C!•IANGES Xc �P� OP WINt7cjW T�1 DE INSTnLLED V �SY�� ��i�c�a: r'� ��„_crrv '�C��� �' �_LEAD CGRT NUMItEP 2•�.,..'"�'l1S crrY� FAX �I� ' , - S[ZE __ STORtES 3/SIIED �V1NDdWS � Di�AlN 1'1LG a c�'r'i•r�r� TIC f+C5l7L Q r�pt?ITiQ� �' ftEMO[7ELING ❑ t•IOUSG (7NLY CI 1-I{7LItiE $; CARAG� ❑ t1TTAC1•1ED GARAGF. a o�T�crie� cnr�ncc f�Sof�il [) 'I'ritn p Fi��tCiu LUCATiUfr' OP WWDdWS Pcrmit No,; �L� { E'U c�'��`� _.. _ R�ceived By; I Y� l a�x� ����--��.�a i1 'r� ru��3 crr nTC�lf ��ff�. f3ASEMENT REM[)D •.L.iNr CURMiT� L L•',xiHtin�; I'lcwr Plurt « Pro{�P!K'tl ticxrr�ilnq z. [.i�t o!'xcn�ctur��l rnemhcrv to bcuKr<l POR NGW CONSTRUC'TION INCLUDING DCCI�S, LiI71J1710NS. A: PORCI•IF� �UTiM1T• t. 5ite Plai�fSttrvey xhowing tNc exiw�ing rtructurey iind' propunccl pfojcct. 1, Tw� xcts uTconvtructicin pl�ma ;. Cnergy C�lcidntiops POR WINDOWS - PROVIDE U•VALUE AVp MA�UfAC'TURE STICKER C!N W1Nf.)C)W. ON VALUATIUN, INCLIJDING T13G CQST O� �.AaC1T� � __ (USII�IG THE ]`997 U.H.0 FEE SC!-lEDULE) ��cn��t r•cc � �"� �J Scc Buck Pagc f�r F�r Se1lecJule � Plnn Revicw S fi5'% of Suilciing Pcr�nit l�cc �irc; Surcharge � �.00 t tnr�e� the tutul job valt�lition 5urchurSc � .b005 x['c�Yrtit Vtiluulian Mirti�nu��� 55.00 Liccnsc Surcharbc 5 �S.OD (SiE1tQLICG1�Cd RCSjdl:tllla� COI1tr;�GtOP�j S,RC Ch�r�c � $2�30 ��cr S�C Unit (Pl�ns t� MWGC t'�r detcrrnination) Curb �ut Eycrow S {� + C� �l = 11 x$�S= � Er�sion Cun�rul $ $4S� Gontictvation Plsn Rcvicw �ark rec � Fcc Dctcrmincd by �nbinccrinb Scwcr Muin Chargc $ AKrcemcrtl ncccss.�ry () Non Nc;cc:.ciiry () Totai Uua _ $ �� �Vlskc check. p�v��Ie ta: Cirv of F'ridley Attacl� StI�rulutiatts T1�115 ts AN Al�PL1CATll7N T4R A 1'GRNlIT-NOT VAL1I5 UNTIL f�RQC'ESSED I hcrcby nppty fur a builcling permit �ncf [ uclu�ow}cdgc Chat thc iiiCorinatiori ab4vc i� c�n�nlcle �ncl accurslc; lhat thc we�rk will bc in conforniancc wi�h thc ordin�nccy and cr�dcw ol'tlte City of i�ricllcy and witlt tl�c Minrtcs�ut Constrti�ction Codcs, tliat [ uncicrst�tnd this i:+ nc�t a permit bu� only an apnlication Cvr a pcm�it :trtd wark iw nol lo ,�4sri withaut a�crrnit �n sitc: th��t thc w�rk will bc in t,cecrrclun�c wlth �he approvcd plFUi in thc casc of aI1 pr�C whiclt r ires rcvicw and apprtrval af p1an�, .• /I S[GVATURE OF APP�ICANT�,/il�,�*„�� �� PRINT NAM� ��,�_�Q���, ppyL_L� L L�� AI�PRt7VAi. Ih1S�RfT(7R CIGNATIdR'.F .