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AF - 43259sue�ecT P IT NO. City of Fridley o 18277 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r ' ' R � � � � • COMMUNITY DEVEIOPMENT DIV. � ' j V �.'�� , � r � � PROTECTIVE INSPECTION SEC. � � � � � /'��1 � CITY HALL FRIOLEV 55432 NUMBER REV. DATE PAGE OF APPFlOVED BV �"""�� ,�� 612-571-3450 910-F15 11/4/85 � � JOB ADDRESS 1320 Creek Paxk Lane 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 2 Hidden WOOC�S SHEET 2 PROPERTY OWNER MAIL ADORESS ZIP PHONE Garjac Construction Co. 481 - 20.6th Avenue N.E., Cedar, MN 55011 434-7096 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 AFCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO. 5 ENGINEER MAI� AODRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK C� NEW ❑ ADDITION ❑ ALTERATION O REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WOFK Construct a 38� x 25' Dwelling and a 22' x 20' Garage and an 8' x 10' Deck SEPARATE PERMITS REQUIRED FOR 9 CHANGE pF USE FROM S, � ► STIPULATIONS provide a hard surface driveway. Provide City with copy of verifying survey before capping. Provide sod in the front and side yards. Paid Park Fee of $1,500.00 and driveway escrow of $297.00 (16'+6'=22' x i3.50 =$297.00) SEWER LOCATION: (Approx. 8` Deep In Street� 170' W. of M.H. (Inv. 882.57) WYE ELEV: 883.25 TOP OF FOOTING; 886.75 Minimum WATER LOCATTON: West of and In Same Trench as Sewex Serviee. THE CITY OF FRIbLEY IJUES NOi GUARAN7�� 7HE �A��, /�CCURA�Y OF UT;LITY L.OGi1Tit�NS AfJD ELE'JATIONS, 3'HIS DATA IS FOR tNF'; RPv1,�7'iON PURPOSES ONLY, Before digging cali locai ��iili;iG� qND PERSONS USING TNIS INFORM,ATION SHOULa TELEPNONE • ELE�TRi� = GAi EY=v. v�R��+ �r orv TH� s1rE, � �� _.� � � � 4� �3�i° �.1��°,�_, TYPE OF CONST. OCCUPANCY GROUP OCCUPAtJCY LOAD SEPARATE PERMITS ARE REQUIfiED FOR EIECTRICAI, PIUMB{NG, HEATING, VENTI�ATING OR AIR CONDITIONING. WOOC�{ FYdI�e THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, Ofi IP CONSTRUCTION R^1 1031 + 440 OR WORK IS SUSPENDED OFi ABANDONED FOF A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ]. STA�LS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �`S9 9OO 529.�5 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVI IONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUC ON OR THE P�RFORMA E OF CONSTRUCTION. $313.00 $425.00 PLAN CHECK FEE TOTAL FEE � /�' Q'� $ 78.25 $846.20 +PF & DW si�NnTU oFCON�ancr oan THOR12EDAGENT IDA, E� WHEN PROPER Y VALIDATED THIS IS YOUR PE MIT J l( 1 G S�GNATUREOFOWNER�IFOWNERBUILDEAi �DATEI BIDG WSP D/.7E � NEW [ � ADDN. [ ] pLTER. [ ] Construction Address: Legal Description: City of Fridley � � R-1. AND R-2 j Building Permit Application 13�0 oT' 3 C�. �k -�.�ae �• � V��d Effective 4/1/84 �� Owner Natae & Address : Tel . # Contraetor : ��%�t `T�� CO '�sl Co Tel .� y3y'�7a9� Address • `%g� � D � � � �2 /v� C.e��E �1t/, S'� / / Attach to this application, a Certificate of Survey of the lot, with the proposed construction draWn on it to scale. DESCRIPTION OF IMPROV �� <��'�— 8 ( LIVING AREA: Length 3� Width 2 S� Height GARAGE AREA: Length �. � Width 2-� Height �_ DECR AREA: Length �_ Width /� Hgt/Ground 6� OTHER: �U'� ( Sq. Ft. _�??'� Sq. Ft. �J yU Sq. Ft. Corner Lot [] Inside Lot [� Ft. Yd. Setback Side Yard Setback Type of Construction• ,�� Estimated Cost: $--_��d Approx. Completion Date: �� N ! S� �9 � �o Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: �6 f�'� 6r �1 �$ 2 q'��_`O $ See Back Page for Explanation � � DATE: l� - 3�� APPLICANT: � Tel. #_ CITY IISE ONLY . Permit Fee Plan Check State Surcharge SAC Charge Park Fee SeWer Main Charge �a � TOTAL STZPULATIONS: $ �("3>vU � •� a� $ `��i,�t � $ U �.c�c� $ is00oC�v $ .� � " E C� Fee Schedule on Reverse Side 25� of Building Permit Fee $.50/$1,000 Valuation �425 per SAC U nit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary ( ] \ ��',`��qo - �,�� ,� 0 BUII,DING PfiRMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure,�or for any addition to any existing building or structure, or for any alteration or repair to any existing building or strueture, upon applieatio n therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth�and in the manner herein provided to-Wit: Total Valuation �1.00 to �500.00 �501.00 to $2,000.00 Fees $10.00 (Minimum Fee is a15.00) $10.00 for the first $500 plus $1.50 for each additional �100 or fraetion thereof, to and including �2,000. $2,001.00 to $25,000.00 $32•50 for the first $2,000 plus $6.00 for each additional $1,000 or fraetion thereof, to and including $25,000. $25,001.00 to $50,000.00 �50,001.00 to $100,000.00 $100,001.00 and up $170.50 for the first additional $1,000 or including $50,000. $283•00 for the first additional $ 1 , 000 or including $100,000. $25,000 plus $4.50 for eaeh fraction thereof, to and $50,000 plus $3.00 for each fraetion thereof, to and �433.00 for the first $100,000 plus $2.50 for each additional $1,000 or fraction thereof. DRIVEWAY DEPRESSION ESCRON (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50 Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approaeh with 6 inch depth - Driveway Width plus 6 feet times $15.75 VERIFICATION OF FOUNDATION Permits for construction Will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, sho�ing the location of the foundation onee it has been constructed will be required before proceeding with the framing. ��CfU�. Uv �. �v� — �� -� � vPPr�1 L � U�c. � � lf�' � ag'`3.00 Ft�4r..� ��i = 30, � � ____-- � � � 3. �� = 9 ae� Y �l�l . �� z�.II,q°�,� $ t x y�[. i�1 3 s�.� ay �r3s � 9 �z X q.4ti �'LY�� 2 �iNa�r �a.t� g o�.� �' s,3c3.6� �i,g,8.9� oti s�i.�o°. �'L' .. . . _: 1 f.lY.•, �� U6UR6AN . .. ..e:+':. ,••,.u•.wn. h�. ct� ', i ��N � 1 N E E R I N � __—"_. ___— --_—__�'____ __." __"_" __.—__ �".,"___� M.�nn�-x�t� 5-�::;: -_____ _ ir.c — .. �1 �1.., •i��a N4pGh1( � • l..�E !'.o�w,•y . . ' fi:i �:�•� M��..! . . , � �,� ii l.Nuu��.�� f.n��n.....,�' �. wi l.,i.nr � i.�nE �.. �.. �� 1. d.� n..��.r M�r�nw�• 5`.�.f � �� Certificate of Survey �for Q �� ,� � rza �.�� ;v � � � r��,� <�y � ,,4<< ;,"� s �u3C "S '• , ! ,`t\�\ a �� ,;1� 1�:+�•a � �;c,=. � �� }C°- �`�:��;�'�� ^ '�� ti�� ? �� . �jt �; "�c „�".`.:� `� . ,::1�'�.y,.� .. �G�! ..�s i; e.� v-!•` � �`\ �. C�,�.,�' QF F�'��` ` r( l-(� , r,�; ` � '' � �,'\ �`�r `` ��Jv L�\�' �+�� t"��.``�1`%�� .�`\ J ��{1C:] \1V\ `7 1��,�� `��1�C1\vc� vc;��\��,. . �� {5 -�N �N� �� N v -. � ,,. � ��.-.--.r.� � � �L¢V (�.0� � �NE ��E� �;�.�5• i �h � � G,, � . nS�� , CQCE � / �5— EAST 75.00 —� ft�� ` s ;, ,' ` � .�, / va. O � . ., a�� .�„ ; �.3. �i.,ti .-.v. a;-��r��?�7� * "�` �,R.y�� " �C ,� ► �� oZ� S � o�i = tia ��1 ti z ek�. , IoL:s Q � �iev �� ro�.5' l0��0` W � �— ' i5.00 - e�sr . OQ�?�� LAN� • , C �-� S-4�tee-{- f�SS� ,..,Q� 100 . o ELevsl+.�..� 1,� = 4O, . ^ � c:.c1 � � \�pQ �� _ �i c ..�� ' -�� 7`"•��`Ei � � /V � � l %O ��, o�- .� � �,�v� ��, � � � � �� -- �'g� _ �-5 �� , , � , �S �/�,v.�� v � / G �� i � ��' , {1%s"� d F �"�' p � `� � E ��'�tiCf/ � S ��,.v � � � � f' V i c �e. 17� .y �go �� - � �-� �� 3 � -� .O� ,� d� � � T :1vr�- � =- �� _ . _ � css� � � `s° � dv � 3 �� % � �� 2� / G �� v / S ,. . . .- sue.;ecr PER City of Fridley 29261 AT iHE TOP OF TNE TWINS B U I L D 1 N G P E R M I T i � � � • COMMUNITY DEVELOPMENT DIV. ' ; V' � �l f � � � PROTECTIVE INSPECTION SEC. d/�`� � . ' � �"'1 � CITY HALL FRIOLEV SS�,I NUMBEii AEY OAfE VAGE Oi APVROVED 6Y �'""�� '' 612-571-3450 9t0-F�5 4/21/99 / � JOB ADDRESS 1320 Creek Park Lane NE 1 IEGAL �OT NO. BLOCK TRACT OR AOOITION SEE ATTACNED DESCR. 3 2 Hidden Woods SMEET 2 PROPERTY OWNEF MAIL ADDRESS ZIP PMONE Janice Hicks 1320 Creek Park Lane NE 572-9729 3 CONTRACTOR MAIL ADORESS ZIP PHONE LICENSE NO Affordable Custom Homes 680 63 Ave NE, Fridley, MN 55432 574-0729 %�B� l ARCMITECT OR OESIGNER MAI� AODRESS ZIP PHONE LICENSE NO. 200055329 5 ENGINEER MAtI ADDRESS ZIP PNONE IICENSE NO 6 USE OF BUILDING Residential � CLASS OF WORK O NEW O ADDITION O ALTERATION C� REPAIR O MOVE O REMOVE 8 OESCRIBE WORK Reroof House & Garage (23 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to 9:00 pm on Saturday; No work on Sunday. TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD SEPARATE PERMITS ARE REOUIRED fOR ELECTfiICAL, PLUMBING, MEATING, VENTILATING Oq AIR CONDITIONING. THIS PERMIT BECOMES NULI AND VOIO IF WOFK OR CONSTRUCTION ZONING SO. fT CU fT. AUTMORIZEO IS NOT COMMENCEO WITHIN 60 DAVS. OQ IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANOONEO FOR A PERIOD OF 120 OAYS AT ANY TIME AFTEF WORK IS COMMENCED. NO DWLG. UN17S OFFSTREET PARKING I MEREBY CERTIfV THAT 1 MAVE REAO AND EXAMINEO THIS APPLIC�►TIpN 1 STA��$ GARAGES AND KNOW TNE SAME TO BE TRUE ANO COfiRECT. ALl PROVISIONS OF LAWS VALUATION SUFTAX AND ORDINANCES GOVEFNING THIS TYPE Of WORK WI�L BE COMPLIEO @ WITH WMETMEA SPECIFIED MEREIN Ofi NOT. TME GRANTING Of A PERMIT W 1� 971 �. 9H DOES N RESUME TO GIVE UTMORITV TO VIOLATE OR CANCEL TME pEqMIT FEE SAC CNARGE PAOVI ONS OF ANV OTH ST TE OR LOCAL LAW REGULATING ON- @ STR TIO R T E ER RM CE OF CONSTRUCTION y�6Z.2S Fire SC �1.9% PLAN CHECK FEE TOin� FEE v? License SC $5.00 $70.20 S�GNATUpEO� ON' ,TpROQ�UTHOAIzEDeGENT �r � WHEN PRO RLV VALIOATED TF�IS IS �OUR PERMIT , �-, - Y- ��.�9 i S�Gtia�UQE O� OwtiEa ��c pwHEp BUi�DEQ� �D�TE� �OG �a5� ��it NEW ADDN ALTER [l [��]' _ d/I ConstructionAddress : Legal Description: �.; Owner Name & Address: Contractor: Address: LIVING AREA: GARAGE AREA: DECK AREA: OTI�R: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION � � � 0 Effective 1/1/99 �\ � � G'�� '� � � �_ Tel. # ,%G %�� %�9 MN LICENSE # o2DG�SS3� Tel. # �%�%v� Attach to this application, a Certi�cate,df Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Length Width Height Length Width Hgt/Ground �� -��.� _ ��' Sq. Ft. Sq. Ft. Sq. Ft. , , Construction Type:�/r�� . �Pi Estimated Cost: $ ��%� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 F� = Ft x$ _$ DATE: -�l � APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Tel. # , - � $ ��. �� Fee Schedule on Reverse Side $ % %'% .001 of Permit Valuation (1/lOth%) $ �o $.50/$1,000 Valuation $ $1050 per SAC Unit $ O $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] $ . C� f CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 (763) 572-3604 FAX: (763) 571-1287 PERMIT NO.: 2004-02294 DATE ISSUED: 12/17/2004 R�� ADDRESS : 1320 CREEK PARK LN NE PIN : 133024130056 LEGAL DESC : HIDDEN WOODS : LOT 3 BLOCK 2 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 0.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A PH : 612-827-4033 # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS # GAS DRYERS 0 # GAS RANGES # OF NEW FIXTURES 0 VALUE (FOR MINIMUM CALC) # WATER TRMT APPLIANCES 0 APPLICANT NORBLOM PLUMBING CO 2905 GARFIELD AVE S MINNEAPOLIS, MN 55408-2173 (612) 827-4033 OWNER HICKS JANIS K 1320 CREEK PARK LN NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wor] will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local l w regul ting onst�uction or the performance of consiruct�on� Bldg PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) PLBG FIXTURES (EXIST OPENINGS) WATER TREATMENT APPLIANCE WATER HEATER - ELEC WATER HEATER - GAS GAS RANGE FEE GAS DRYER FEE PLBG REPAIR/ALTERATIONS STATE SURCHARGE, PLBG FLAT TOTAL PAID WITH CHECK # 29683 SEPARATE PERMITS RE(�UIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 0 l 0 300 0.00 0.00 0.00 0.00 0.00 35.00 0.00 0.00 0.00 0.50 35.50 ;ITY OF FRIDLEY INSPECTION DIV. 431 University Ave NE 'ridiey, MN 55432 T63) 572-3604, FAX (763) 571-1287 Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR 'LUMBING FIXTURE RATES: !ew Fixtures )Id Opening, New Fixture leer Dispenser ;low Off Basin NO. RATE TOTAL ;atch Basin tain Water Leader iump/Receiving Tank � Vater Treating Appliance 1later Heater -Electric Vater Heater - Gas** �,_ �as Range** �as Dryer•* 3ack Flow Preventer Required ()Yes () No $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 Type $15.00 teinspection Fee $50.00/Hr �LL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25°l0 of Value of Fixture or Appliance State Surcharge TOTAL FEE �..� JOB ADDRESS �r�nnn�. � o�S �� Y��v�i The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stat� �� }h�� <<��- __- �e and correct. HICKS, JANICE 1320 CREEK PARK LANE NORTHEAST �Z� g 20 � FRIDLEY, MN 55432 (763) 572-9729 OWNEF �� BUILDING USED AS �51 �e.YtG� $ -� ESTIMATED COST �� d� PERMIT NO. PLUMBING COMPANY O'i- �f-�` �� U/w1, t SIGNED BY'� / TEL N0. (�012� �Z %— S1033 Approved By Rough-In Date Final Date $ 35 SD OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. ;OMBI,JSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. *'�PROVIDE COMMON VENT INFO ON BACK SIDE , CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 �-,....�-..� - - PERM O.: 2004-00831 ��-�..___ DATE ISSUED: 06/03/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 1320 CREEK PARK LN NE PIN : 133024130056 LEGAL DESC : HIDDEN WOODS : LOT 3 BLOCK 2 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DECK VALUATION : $ 3,427.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. CONSTRUCT A 12' X 23' DECK. APPLICAN7' BUILDING PERMIT FEE 97.25 KIEFFER NICHOLAS CONSTRUCTION PLAN CHECK FEE 63.21 2520 INTERLACHEN DR FIRE SURCHARGE 3.43 STILLWATER, MN 55082 STATE SURCHARGE, VALUE 1.71 TOTAL 165.60 OWNER HICKS JANIS K 1320 CREEK PARK LN NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any her state or local law regulating construction or th erform ce of construction. Applicant Dat�� 13 0 / � Bldg Ins � �Dat�� SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. _ _ _ _________ � �� N� [] CITY OF FRIDLEY ��'`"` – Effective 4/1/2004 ADDN [] 6431 University Ave NE, Fridley, MN 55432 (763) 572-36 Bldg Insp ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-128 Fax BUILDING PERMIT APPLICATION � � � ��-` �^� C � / � � � Construction Address: % 3� O � J'e eL� p,� ✓' � L��✓'� � Legal Description: Owner Name & Address: � J�.,/,� i �i�k eS S�9Me� Tel. # "i� 3 -.�7zr972 9 Contractor: �ic.,�%�Cres �c i rF�evi- ��,/slrU� %°°^' e°�v° MN LICENSE # Address: �S �a /.�f%v'Lr��.�/ �i'ive. s C�GC c,�ariY.- Tel. #�'�� -f��- lS�''-$ o � LNING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the bt, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length /�� Width � 3` Hgt/Ground l 3� Sq. Ft. '% -� �T �,/' "�T7' ��_%. /� Construction Type: l fC � f�� WoU� Estimated Cost: �_r �� Driveway Curb Cut Width Needed: t. + 6 Ft = Ft x$ _$ DATE: O S ' /3 O_ci/ APPLICANT: ,�C�c � �f �� f=�°� Tel. #�'l� �SS� =/S�5 Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. ' CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL � � � $ � �/ � :�.y� � I.7/ $ $ �—;r ',�'� .—T�� $ $ $ $ � L $ �� -� �,�� i Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] ,�C' �' .(�� STIPULATIONS: