AF - 42904�* �
* PION�LR
* ene neer
** �*
Certificate
�:1
►' �
�.
��
LAND SURVEYORS • CIVIL ENqNEERS
� LAND PLANNERS • LANDSCAPE ARCHITECTS
2422 Enterprise Drive
Mendota Heights, MN 55120
(812) 681-1914 FAX:681-9488
625 Highway 10 N.E.
Blaine, MN 55434
(612) 783-1880 FAX:783-1883
of Survey for: THE RO TTL UND COMPAIV Y
House Address: a�� ��►��-���s�,� �.,�-
House Model: ����` -
----------- ------------ ��
_ .—�'-�.,� -- _ - - — - —
/ � � ---� 9����'E
�' — --- 8�__ , —96.00 �� ------
� � �.� �_- oo -f -zo —�- zz.� -*
// / } . � � � � _ � ' _
/ i� ze.00 ao �za Ze.00 � � �
� /�� 22.33 7.67 ,�12.33 12 N 7.67 � 22.33 859,'14'
859.SZ '�3 � g 8 " � I
�� �34 g 35 � 36 g 37 �
' o � � !1�' � l��t � � �� � 42
,� 3.0 �� PRO OSED � a.a W I
�� V
�\
�\
�
\\
\\
�
\ `
�
��
�
gg .
g�
�
86a.10
25.33 20.Oe0 3 K 20.00 25.33
�.00 20.00 20.00 ' 28.00
TO HOM BUI ING
41 ��
�°� � �.�
22.33 �
�.00
S�
�S
Z
�$g3s�� 38� �
3 �o�, � �o� � I
12.33 12.33' 7.67 � ��
�.o0 2a 28.00 � (_
. _ _ �
�•
� ^ zz� �.-- °°- ,� i4 � rl.�s
� i� i
'""'�— S 59.4 S
t -i {. -- �
359. 4
S89'46��•E —�o�_
�-`�_...�-- - - - - - -
�
�
\ r- — --T — -� — 1--
�`� I I i I
x eoo.o Denotes Exlsting Elevot�on
� Denotes Proposed Elevatfon
--� Denotes DroPnage f7ow Dtrection
� Denotes Drolnoge dc Utillty Easement
-�- Denotes Monum�t
—$- Denotes Offset Hub BearTngs shown are assumed
� �
I I
•;i�_•� Jl� ► ► r►. ?I_ ' � jl.,�
Garage Stob flevotion: ,861•05
NOTE: Propoaed buAdTng sita groding ta in accordrnus with the
groding plane approved by the clty aiqtneer.
NOTE: Contraotor muat verify aU dimenetona k driveway deaign.
LOTS 34-41 , BLOCK 2 CH.RISTIANSON CROSSING
Ad�ad ex:sT Ql e�r 6-Z3 9b ANOKA COUNTY, MINNESOTA
We hereby certify that thia survey, plan or report was prepared by me or under my direct supervision and that I am duly Itcenced
Land Surveyor under the laws of the State of Minnesota. Dated this �H day of .� u�.e A.D. 19�.
Signed: PIONEER ENGINEERING, P.A.
—�— ��
• 1 '�ch = eet _ � BY . � ���.�...sz_ G. �aei���-�.
S c a le . 1 � 0 Robert B. Sikich, L.S. Reg. No. 14891 or
3� 16190.05 Terrence E. Rothenbacher, L.S. Reg. No. 20595
SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D i N G P E R M I T
r
i �
� �
COMMUNITY DEVELOPMENT OW
r � L � PROTEC7IVE INSPECTION SEC
i----'� ��"';'� CITY HALL FRIOLE� 55432 NuMBER REv
i 612-571-3450 9� 0-F� 5
JOB ADDRESS
172 Christenson Court NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 3S 2 Christenson Cro
2 PROPERTY OWNER MAIL ADORESS
The Rottlund Co 2681 Lon� Lake Rd, Rosevil
3 CONTRACTOR MAILADDRESS
Same
4 ARCHITECT OR DESIGNEii MAIL ADDRESS
DATE PAGE OF
10/30/96 / /
ZIP
ZIP
5 ENGINEER MAILADDRESS Z�P
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION ❑ ALTERATION ❑ REPAIR
X
8 DESCRIBE WOfiK
Construct a 32' x 25' Townhouse & Garage
9 CHANGE OF USE FROM
TO
��7�5
RECEIPT NO.
APPROVED BV
SEE ATTACHED
SHEET �
PHONE
•0500 1335
PHONE LICENSE NO
PHONE LICENSE NO
PHONE LICENSE NO
❑ MOVE ❑ REMOVE
STIPULATIONS See notations on plan. Paid Park Fee of $375.00 x 8=$3,000.
TYPE OF CONST. OCCUPANCY GROUP � OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAVS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS
I HEREBY CERTIFV TMAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VAIUATION
AN� ORDINANCES GOVERNING THIS TYPE OF WORK WILL 8E COMPLIED See 170 Christenso
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE-
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- See 170 Christenso
STRUCTION OR TH E OF CONSTRUCTION.
� PLAN CHECK FEE
� 9 See 170 Christenso
� � �
SiGNATUAE OF CON�AACTO OA A THOA�ZED AGENT IDATEI W,k1EN PNOPERLY LIDA
� __ � _,
a
SiGNATUAE OF OWNER �iF OWNEP BUILDEAi iDATE� BIDG �NSP
CU. FT.
OFFSTREET PARKING
IGARAGES
Court
AC CHARGE
Court
OTAL FEE
Court
i THIS IS YOUR PERMIT
CU-� ,�a—q�
fiFTF
Prepaid Plan Ci�ck $
Estimated Cbst $
Receipt #
C�1�_ �, �: i�, � _
' •� ( Iy'M• : I 11 . • .
�:! )I 1.1,. �Qy:1/l1 s ii .. _ 1.�.►
• • ��• - �� � /
ll. . .
I -�_ �- M • • _j � � � � i' � � l 1���v � C
• - •..• - �1_ ��1� .� _�: �,t�.� . _ .. :.. . u :r•�7
O�NTRACIOR & ADDRFSS
Architect & Address
F�gineer & Address _
Effective 3/1/96
• •
Tel . # �03� • C�',�ao
Tel.#
�.# 1 qO15
. .S'ltol
TYPE OF �RK � New [] Addition [] Alteration -Describe `�(Q(�� �,A��
U��r� owNN�rrrF ��,t� ►tir�
• •�• - • ' i� �::� /[ /[ _` �,�..i_ �/ - . i ��r �• �: - y � �
_/�
T E+ngth
Width
i_�o�■ � ��; � �„i�;��.-� r�!.
Height Sq. Ft. # of Stories
p�, p�,p,: T�+ngth Width Height Sq. F't•
y�SE p�tF�: jle,ngth Width Height Sq. Ft •
prj� p,REA: T Pngth Width Height Sq. Ft •
VALiL�TICdJ
Sq. Ft. x$ Cost/Sq. Ft. = Valuation $ )
sq. Ft. x$ cost/sq. F't. = valuation $ )_$ �
sq. Ft. x$ cost/Sq- Ft. = valuation $ ) 'I�l�AL vALUE
Building Use � � L Construction 'I'YPe " ��1CY �uP ��3
Ai r Conditioning �Yes ❑ No Fire Protection Provided [l Yes � No �°WN��
Perfozmance Bond Amount $ %� See Rev�rse for Schedule Received. ❑ Yes [] No
Pexmit Fee $
Plari Check $
Fire Siaz'chas�le . $
State S�az'charge $
SAC c�arge $
Erosion Gontrol $
Park Fee $
spec . Assess��ents $
nriveway Escrav $
Tt7I'AL $
See Fee Schediile on Reverse Side
In �ccess of Prepaid Amount - See Reverse Side
.001 x Pennit Ualuatian (1/lOth o)
$.50/$1,000 Valuation (See-Sched. for > $1 Million)
$900 per SAC Unit (Plans to Nb�TCC for determii�ation)
$450.00 �nser�ration Plan Review
F2E D@tPxRLl11E'C� Bj� F4i� n�ri nc7
Agreement rrecessary �Ll ,Not Necessary Ll
, feet x $13.50/foot
$1 to 500
501 to 2,OOp
2,001 to 25,000
25,001 to 50,000
50,001 to 100,000
100,001 to 500,000
500,001 to 1,000,000
1,000,001 and up
$1 to 2,000
2,001 to 25,000
25,001 to 50,000
50,001 � to 100,000
100,001 to 356,000
Over $356,000
�3UILD..T�i iG PERMT�' FEE SCHEDLTI,E
$21 (Minimum Fee is $21 plus surcharge) �
$21 for lst $500 plus $2.75 for each addn'1 $100 or fraction, to and includ
$2,000
$62.25 for lst $2,000 plus $12.50 for each addn'1 $1,000 or fraction, to a
including $2S,ppp
$349.75 for lst $25,Opp p1us.$9.00 for each addn'1 $1,000 or fraction, to a
including $50,000 � .
$574.75 for lst $50,000 pius $6.25 for each addn'1 $1,000 or fraction, to a
including $ipp,ppp
$887.25 for lst $10U,00p plus $S.pp for each addn'1$1,000 or fraction, to a
� including $SOO,OOp _ . �
�$2887.25 for the lst $SOO,Opp plus $q..25 for each addn'1 $1,000 or fraction,
� � and including $1, 000, 000
$5012:25 for the lst $1,OOO,ppp plus $2.75 for each addn'1$1,000 or fraction
P�PAID PLAN.CHECK FEE SCHEDULE
$29.25 a
$29.25 for lst $2,000 plus $5.85 for each addn'1$1,000 or fraction, to and
including $25,000 .
$163.80 for 1st $25,000 �lus $4..225 for each addn'1$1,000 or fraction, to and
including $50,000 '
$269.43 for lst�$50,000 pius $2.925 for each addn'1$1,000 or fra.ction, to and
including $10p,000
$415.68 for lst $100,000 plus $2,275 for each addn'1$1,000 or fraction, to and
including $356,000
$1,000 (Balance due with issuance of buildi.ng permit)
PERFORMANCE BOND POLICIES
When a building permit is issued for a commercial, industrial or a multiple dwelling residential project which re uire
outside improvements,a Performance Bond or a Letter of Credit shall be submitted to the City. The bond willc ove
all outside improvements, including but not limited to landscaping, imgation, curbing, blackto in scree '
lighting, and storm drainage systems. PP g� ntng fence�
Calculation of bond amounts will be determined by the builcYin
building penmit value up to a 2 million dollar ro ect or a$60, g��it values. The bond amount will be 3% of th
P J 000 bond. Actual amounts will be rounded to the neares
$100. The City reserves the right to require greater or lesser bond amo u n t s b a s e d o n u n u s u a l c i r c u m s t a nces. Pro'ect.
w i t h n o o u t si de improvements, generally will not require a bond. �
Bonds must remain open until the project is fully completed. Al( bonds wiil be held over one winter and throu h'the
next growing season to insure the survival of all landscape ins�a�o� �e City will then inspect these propertie:
in August of the year following the in.itial planting, _ Bonds may then be released in October of that year if al
improvements aze satisfactorily completed. '
�
�
�,
r
�
�
�
c
O
m
>
�
m
W
�
0
z
O
�
U
W
� W
z z
�ij Q �
� �N �
� � Z
v
� c � �
o � m �
� � I
U � ti ii
0
v
�
�\
ti
�
.`
�
�i
�
W
�
�
�
Q
m
O
�
c
�
`m m �'i
L 'Q �
Y (0,� �
O L ,�;
3 �' " o
m U � m
.t.. � � O
� �_,. ,= U
`- Y � c
� 3 m �
�
�
m
N U U 7
� � � m
� � � �
� U m C
C U m O
O � t �
� � 'U U
U i = �
a � � a
a c � �
�YO�
Y `o � �
ec 3 p �
E � � �
�. 0 5 m
m � � �
L p� m C
-Q � m o
m m r �
rnm"- c
� o m
N � fq y
�
-mp � C a
C
7 U �. �_
m m v a
� a c c
H N N (Q
co
rn
rn
ii
V
I
\ r,
�
�
��
\
�
�I
c
\r�
�l
3
�
�
�
\
. `\
�
�
� \V
Z \`
H �
� �
Q
W �
a �
� �
�
n�
'9
�
a
0
Z
J
W
F-
1
0
I Z �
Q �
a
� �
� o O
� U C'3 m
_ � Z
N
� � c m W
C 'Q � � Z
Y � �
O m w a cn
� G �
o � . �
0 0 0 0 0 0 0 o p o 0 0
0 0 0 0 0 0 0 0 0 0 0 0
W ' i: v ui r.: i: �: r: o �.. o 0 0
Qf» ts� tA vi t� �� vi � ifl in i�
�
0
0
ui
�
z GI I I I I I I I I�I I Iz I
N
N
r
v
� �
�
¢
� � � � ` y �
� m
�, 3 m F� � � � c
X �Z � C' Of C'� W � � �
m
� y � C � C `'Z C m m # # d
z �`c n. m� m m m m m�rn m. 3
� �000m3�`?=�z�°„
� m � m a � m � � � � � � � t'-'
a zommc�rtu�333c7c7m
�
�
t
:
• Y �
p �
C F
LL �
0
U
0
�
e
�
�
� �
0 �
c :
m o
'o >
� �
�
a
�
u
u
u
�, u
m �
� �
N -
� s
O
a �
¢ :
�
Z
O
H
Q
�
W
�
J
Q �
0 U
Z �
a co
� a
� a
Q
= a `o
� w
O � j
�
N � O
� Z �
LL' a 7
O � �
:-. w >
� � o
� o �c
o°'C Q T
�
� I�,
�
v� v>
N
�
�
t
U
�
�
a�
�
�
w
w
�
�
�--'
O
a
�
�
, �-
�
1
�
1�
m�
�
�
co
�
�
�
�
�
�
c
O
m
>
U
�
W
�
z
O
�
}'-
Z
�
>
C3 �
�" U
O W
O
�
U �
U' Q
Z G�
F- �
'.Q'J }'-
_ �
� �
�d `�
Z
� Z
Zq �
a Z
W �U
� �
oa
aQ
� Q
LL Z
Z O
O Q
U �
J �
a�
g�
>
a
Z
O
f-
U
W
a- w
� Z
Z �
} ¢ N
� � �
Q y tA
l�L � Z �"d'
� _ � O
� � � C7
T I
U�ii�
4
m
O
�
�
c
c m
m N �
� � �
� t O R
�c (� d!
`o >, �.
U m
.c m � -
` � _ U
m
o s � o
�
3 t V—
� � 4/ � -a .
a o " �
Q c m �s �
� �s ca q> S
� 3�
i L. U Y
� U �
� U � �
o .� � �s
�� ° m o
�y m
Q y = �
� � � U
Q
.X Gf
Y O = �
� 3 o y
� y �
�
� � D �
'a
� �
m
� O � �
t � � �a
-� _ — N
� a m =
� � � �
� � � �
� �U y m
3 'V �+ y
c �
r' N i �
e
U
�
Q
� Q
� O
� ` �
O
. � �
J O� O\
� O' O
�
�o 0
��'�`J x
��
� �c
�
L �,
� �
� c
� �
m �
.i
U
� U m
� � �
� E � 3.
�
� � � m
� y � m
C
_, � C m
Z
m
co cj � m �
C V N � fZ
d � � �a
v � p N
N j y l0
� lL Q C�
¢
w
Z
O
.
.
�
Q
0
�
�
�
�
Z
n
J
�
oD
1
`✓I�
�
,�
O
Z
F=
�
a�
W
�
�
Q
�
�
�
F—
�
O
U
0
t1.�
Q
�
�
�
O
' G
O
s�s v3 �
O
O
0
�i
�
�
C
�
�
N
lQ
�
O
O
0
�
�
�
�
l�
�
� �O �'
� tA '
N
Fss
�
��.
�
�
m
N
�
Q
1
DD
C
C
O
C•
O
U
Q
�
a �, �
. � �
� �
� �
� "C1
m
i0 l
� �
� �
= p � W
.� m W p �
� N ,J Z
� � � N
� � �
Cvi � U
m
o �
� _
� a o
U
� �
� �i O �
U n. 1- _
� _
N y � m
� �
c m
m
� t c�a
_ � t--
Z �,
O � �
Q � � i �
Z�"'�LL mCll
�� �
i �
�
� �
U
m
�
0
�
� Y
�o
� �
�
O �
� o
� m
� c
a�
� �-
� O
m m
3
� j
m
L 0
a\
Y
�
0
m
U
�
�
� �
b �
a Q
3 ""'
O
L m
� j
� o
� o
E �
E N
O r
U
m
a�
�
S
�
3
�
�
�
�
���
�
W
W
�
�
Fa—
0
�-
�
}
Z
Q
a
O
U
C�
Z
Q
W
_
�
�'^
'�l Y
� Z
Q1
H
�
(1]
�
�
�
�
�
�
w
ca
0
N
c
�
Z
0
z
O
d �
p U
c ll-
� �
= W
>
O Y
LL Q
F-
�
` � W
- O U
��' Z
w �
0
a �
m � u-
-a Y F-
Z
> Q W
O n �
� j U
a og
J �
_ W
� �
�
O
�
3
� �
c� m
'' 3
� O
w �
��
� �
O
-a a.
U �
L ��
= Ll C
00 �m o
� O �
�
c
W c o
� �
� � O
Z
O C u�'1
� O
W � m
o a"
Z V m
� . $,.'
� a �
� k
, .. :.. .i,... „ ..,. . .
� ,,.� .... ,�_. . _.
''.��-� - .. ..... � . __ ..
HOUSE HEATING TEST RECORD i���` I/ �
��. � c
ADDRESS APT. FLOOR CI'TY �SU�URB
OCCUPAF�T '' � OWN E R
HEAT L�35 'D. HTG. INS � '�
SOLD BY � �' INSTALLED BY ,
Electricol Work Br Gas LM� Br ��
TVPE OF MEAT GA FA�HW STEAM SPACE HTR. UNIT HTR. O?HER
MAKE
Mod•I
S�rial
INPUI
TH E RMOSTAT ��
Valvs
Limit , ,,,_^
Limif S�ttinq
Fan Setting _
Pilot Type _
Pilot Make _
Pluq
CONVERSION
MAKE OF BURNER
Madel
Ma�c. BTU RoHng � �
MAKE OF FURNACE
Model
Vsnf Size . ����
KIND OF LINER SIZE NONE
D�aft Hood R uloror ��� � ��� ��°a�'� �
Filters Size � um�er��
Chimnsr, Location I�aide Outsids
CF►imney ConstruCtion
Pilot Model °�d Smoks Bomb SMiring /
Pilot Timing ����-�— OraFt Tsst Te�
�.
L.W. Cut Off �'^'"` Door Pressuro Lightiny Inst. '
� c�'Ci �, ,,,r
Pressuro Psrce�t C0� Date Tested
Input CFH � Psreset 0 � Compony Testing
Staek Temp. G�-��_ Peresnt COZ Name of Tsstsr � �
Form 235 -
,,.
M1 a t ,� , � � ,
_._ . . ... ,. . .�.. ,:::.,., . ,. .., :_._ .,.. : , .., :.�: , � .. .... . .. . . . . . , � . . .:.,� ,., _ . . . _� _�. � .. .. ., . .. . . . ..
�
_
CITY OF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN ��-�3? •(612) 571-3450 • FAX (612) 571-1287
June 20, 1997
Rottlund Homes
2681 Long Lake Rd
Roseville, MN 55113
Re: Final Inspection at 172 Christenson Court NE, Fridley, MN
Dear 5irs:
A final inspection was conducted on June 19, 1997 for the above noted townhouse. We found
that the construction of the building unit complies, to the best of our knowledge and belief, with
all the requirements of the building codes of the City and the State of Minnesota relating thereto,
and permission is hereby given for the occupancy of said unit.
If you have any questions on this matter, please feel free to contact me at 572-3603.
Sincerely,
il
�, � ��
, ,. �., ,
BARRY RIESCH
Building Inspector
.. �
' • • • sue�ttr � P 1
��v4 � City of Fridley � �
°� �• AT TNE TOP OF TME TWINS g U I L D I N G P E R M I T ����
' � COMMUNITY DEVELOPMENT OIV. RECEIPT NO.
� �, •
� � V •"�"• /�/�
� � PROTECTIVE INSPECTtON SEC.
�_.-n..•. `, • •. P�U
� / ` D�/'�'1 � CITY MALL FRIDLE� SSI�2 NUMB6P NEV O�TH VAGE Oi AVPROVED B�
��----� � �'' 612-57�-3a5o e�aF�s 3/5/99 / /
. - �� ,
JOB,ADORESS � '
° °- ' 170 172 174 176 Christenson Court NE & 201 203, 205, 207 Satellite La e
� �E�� t LOT NO. BLOCK TRACT OR ADOITION SEE ATTACMED
° oescp. '- 34-37 & 38 41 '2 Christenson Crossin SFIEET
2 PROPERTY•OWNER ` MMLAOORES$ . 21P PMONE
-` - � - '
Rottlund Townhomes
J CONTRACTOR MAIL ADORESS Z�F PMONE LICENSE NO
Towa & Count Roofin 1 e S oomin ton MN 55425 545-4233
• AiiCMITECT OR DESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO.
545-4233
S ENOINEER MAIL AOORESS Z�P PNONE IICENSE NO
8' USE Of BUIl01NO
Townhomes
7 CLASS OF WOIiK
, ,.. ;� ,. -,,, O NEW Q ADOITION O ALTERATION � REPAIR p MOVE O REMOVE
a , aescniee woAK
Reroof Building (110 Sq) Tear-off
9 CHANGEOfUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
,
�;�.,:
r`c' . ..:.i�;, .
,'SEPARATE PERMtTS ApE iiEOUIREO FOR ELECTRICAL. PLUMBING. MEATING, �P� �F CONST. OCCUPANCY GROUP OCCUPANCY LOAO
VENTILATING OR AIR CONOITIONINd. '
: THIS'�PEiiM1T'°BECOMES NUII ANO VOIO If WORK OR CONSTRUCTION LONINd SO. FT CU. FT.
AUTMORIZED IS NOT COMMENGEO V�IITHIN 80 DAYS. OF IF CONSTRUCTION
OR WORK IS SUSPENOEO OR ABANDONED FOR A PERI00 OF 120 OAYS A7 '
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG.. UNITS OFFSTREET PARKING
1 MEREBY CERTIFY TNAT 1 MAVE READ ANO EXAAAINEO TMIS APP�ICAiION STALIS GARAGES
ANO KNOW TNE SAME TO BE TRUE ANO CORpECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
ANO OROINANCES GOVERNING TMIS TYPE Of WORK WILL BE COMPLIED
WITM WMETMER SPECIf1ED MEREIN Oii NOT. TME GRANTING OF A PERMIT �9,427 $4. 71
DOES NOT PqESUME TO GIVE AUTMORITV TO VIOLATE OR CAMCEL TNE pERMIT FEE SAC CMARGE
PpOVIS10NS OP ANY OTMEIi STATE OR LOCAL LAW REGUTATING CON�
S UCTION OR T11E PERFOFMANCE OF CONSTFUCTION � 162. ZS �9.'43
PLAN CMECK fEE TOTA� FEE
3 Liceense SC .00 $181.39
S�GN�TUpEO�CON'i1ACTOpONAUTMOp�2ED�GEN1 IOATE� WMEN PAOO r vauonTeo rHis IS YOUp PEAMIT
� � �� l /
S�GNATUpE O� ON/NEp��� ON�NBpBU40Ep� �O�fE� - p( Ib$O � ' ry6lf