P - 39647�0 2
Building $I,Jjj,,D�i�i'ar Permit Ivo,:
Inspections �S�DENTIAL APPI.,ICATIUN Received $y:
763-572-36U4 �j�y OF FRIDLE� Date Rec'c1:
763-542-4977 FAX EF�cr�vE t-i_zoii
DATE .�''a �' l� YOUR$-MAILADDRESS i���c�r��":.'. J�:"a�(4�+ie:�/�7'��+�k �?i�{�;�..�:rLr�.°va.
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THIS .4PPLtCANT IS: ❑ OWNER �ONTRACTOIt
PROPERTY OWNER/ NAME: e��/T F_ �l[ ,�4 �,/�etc: �.�c°i_
TENAIVT fwDttESS: ��a��� frrtA�r�'�L ,�� CTT'Y �K=ti�C.�a b s1'ATE,��.z�
rxoArE: [,�t �c — ?v'� °r`tt',3�
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CON�'RACTOR Np1v1E: ��E A�� r•sr�t r��� ����.r �:"
SUBMIT A COPY OF �c -, �..
YOUR STATE LICENSE STATE LTCENSE #�[r��"'/t,,;�t,�° 'E � r r LEAD CERT NUMBER 9` 1-j�(¢ j-1�� �
AND CERTIFICAT'E C1F ADDRESS: cie��4� �° l t?i/i ,� � CITY f�' r:�Il��Su'�G� STATE,�[,_ZIPs.`� �'�;�
INSURANCE PHONE � � y ,� ^ 1-cai � FAX �C�' ' �ti a: -' �'I
PROPERT'Y TYPE L'J SINGLE FAMILY/NEW CONSTRUCTION SIZE f� J�=-�
❑ TWO FAMILY/NEW CONSTItUCTION 5TORIES k
PERMIT TYPE ❑�DITION t7 GARAGE/SHED ❑ WINDOWS
❑$A5EMEN'T FINISH CI ROOF ❑ DRAIN TILE
❑ DECK O SIDING Cl OTHER
❑ SWIMM1NGPiDOL
TYPE OF WORK: ��v�w xo� corrs�trc'norr C1 ADDITION
t+rMAINTENANCE/REPAIR ❑ REMODELING
DESCIiIBE WORK BEING DONE: ' i C`;[-F;?_ T''`,=r �t- k:,�s d'1�
StZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT ��� �
❑ HOUSE QNLY BASEMENT REMODELING SUBMiT•
�� F SQLiARES CI HOUSE &c t3ARAGE
1. Facisting Fioor Plan
G�ES O ATTACI3ED GARAGB 2, Proposed floor plan
PROPOSED SIZE: � DETACHED GARAGE 3. List of structura► members to be used
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECIfS,
Vinyl OSoffit A�DITION�, & PO�j,CEJ�S�BMIT:
❑ Aluminum � Trim 1. Site Plan/5urvey showing the exisling sUVCiures
❑ OU�er C1 Fascia and proposed project.
Z. Two sets of caostruction plans
Vx QWS 3. Ener$y Caiculations
IN EXISTING DPENINGS C7Yes ONo LOCATION OF WINDOWS FOR WINDOWS - PROVIDE U-VALtJE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKEK ON WINDOW,
OPENING CHANGES &
TYPB OF WINDOW TO BE INSTAI.LED NUMBER OF WINDOWS
ALI. FEES ARE SASED ON VALUATTON, INCLUDING THE COST OF LABOR AND MATEWAL.S:
'OTAL JOB �ALL
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer 11+1aun Charge
/� (USING TH� 1947 U.B.0 FEE SCHEDULE)
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$ �% S' • o"�,� See Back Page for Fee Scheduie
$ 65% of Building Permit Fee
$ �� .001 times the total job valuation
$ .0005 x Permit Valuation Minimam $5.00
$ . $5.00 (State Lieens� Residential Contractors)
$ �2230 per SAC Unit (Pians to MWCC for determination)
$ ft+5ft= 8x$25=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( } Non Neoessary ( )
S o. . Make checks aavable to: Citv oi Fridlev Attac
i � f�i.
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aeknowledge that the infonmation above is complete and accurate; that the work wiil be in
confarmance with the ordinances and codes af the Ci of F' ley and with the Minnesota Construction Codes; that I understand this is not a
permit but onty an appiication for a permit and work i t o start withaut a permit on site; that the work will be in accordance with the
approved plan in the ease of�l! o w� c re evi d approval of plans. /
SIGNATtJRE OF APPi.ICANT L�r�--���.�����.---'"j�s� RJj�1�I�J{�� f�c+i� r��-`-z-?� � DATE €i' =� (' I t
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