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ABSCRIBA WORK BE1NG
From: unknown Page: 2!2 Date: 4/11/2011 10:30:24 AM
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�+ S�DENTIA�., ��'�LICI�T�O�T Rcceived J3y: �
CITY Ok' ��IDLEX D��° � � ��'� 1
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� MAIlV'tENANCEAtEPA�t,
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C.ARAGES
�jtOPOSBD S)T,i3;
PROPOSED Fit3TG1�';
� •
O Vinyl
0 Aluminum
0 orr�a
�
iN T3X15TlNOOCENING3 ❑Yea QNo
�[i FOR NEW OPENINGS-DESCRiHE S17.F; OF
OP13NiNG CHANGES dc
ALL FE$S AR�
Petmit Fea
Plan �teview
Fit� Surcharge
Swcharge
�.icee�sss Surcharge
SAC Gharge
Cutb Cut Escrow
kr+asiort.C`,ontrol
Park ,Fee
S�vcr Nisin chargo
❑ .4DA�CION
o R�rqnFr,tMG
0 IIOC7SE [?Ni.Y
O HOUSE � GARACF,
O ATTRCNF,U GARAGE
O b�TACE{Fp ciARqt}E
❑S�t
O Tdm
� Fascia
LOCATION OP WINDQWS
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CERT 1VIJMBF.R ��` ( � IO '� O f
G�TY S�+P�'set STA�II' SSII�''�
,x G S� a-R7� — e� a c"" ,
t[�S
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ae�x� s-1 u�.� ,P�.�k� �- f�.s�v�Ns..
r 77ti. l.I+tS'h �w.��•Z, �
Bas��NT �r�►�!en�cn?c sc tKrP�
1. Existing Ftoar P1an
2. Proposed flax pi�n
3. List of al�uchaal manh�rs tp bp U�d
FORNLW COiV&7�UCTtON Q+1�idJnING DECKS,
AnDTfIONS_ & POELrsr�4 SUAM[T�
1. 3ihe PlanlfiwvaY sbo+wingthe eadsttug strucwres
� Pr� rn+J��
2. ?wo seta of caunn,ction piens
3. F,ner�y Calcutat9ans
tOR Wrninbws — aRpVln� U•VALUL Axp
MANtJFAC'iUR� STTCTCF,R pN WRQDOW.
ON VALiJA'tTprT, nVCI,UDIPiG T�C� COST OF I.�ASOR
�` ,(TJSLN�}THE I997 U.B�.0 F�� SCIIEDUI,E)
s r 3�^� sec ��k ra�ee for Fee schulva�
� 65"/0 of Buildiog Pennit Fee
S •001 times the tatel job valuation
$ .0005 x Permit Valutttion Mini�um 55.00
� SS.QO (S�tc Lic�eqsed Residtnpst Contractars}
� $�230 per SAC Unit (Plans to IvIWCC for detcnnination)
x ft+68� ftx$24=$
� $450 Conservation Plan Revicw
� .Fee 17etermined by Enginee�ring
$ . ,. __ Agreement neassarY ( ) �Ton Necescsry ( }
TBiS �S AN AFFLICA7TOIV kOR A 1'ERMIT-N07 VALtA 17NT7G PR.00ESSL•D
� he�bY �p1Y for a bui�din� pe�nnit and � acknowiedge that thc information abov�c is complete end accurate; that the work will be in
coafonmunc� with the ordioances �rtd codes o;f the Ci#y of Fridlcy end with the Minntsota Conshuctiap Codos; that I understand tbis is Aot a
peamrt but oaly aa application fiar a permit work ' not to start without a pamit on sit�; that the work wiU be ip aecordance vvith tho
apQroved plan in the ca�c of a o� w rcg 4' w and approvat o�' pl *
SIGNA� OF APPI.iCANT . PRiNT NAML•�� i�% d• I� DATE �^ l �I ^ L l
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