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P - 46803cuit�ri-ii i�+:�r� B�ildin,� Inspections 7G3-572-3C04 7�3-502-497? FAX 51T� ADDRESb" � TkfiS APPLIGANT tS: ERTY OWIV�RJ I � TENANT , suaM�T � corv aF YOUR STAT� L1C�NS� A.ND C:L�RTIFICATL �F INSURANEE TYP� From: HomeSure Page: 4/5 n�iiic�ui�� Date: 11/17l2011 2;22:42 PM �Ga ��" tro�l �'UC-�hyru r �+/a $LJILI)1NG ��D�NTI,A.L A�'�'L,ICA'�I�N' ��.'' �J� F1�IDLTY Y�UR E-MA1L ADdRESS Q l7WNER �ONTRA{:TC7R 0 STAT� GtCENw� bINGLE rAMILY/NEW C(3NSTRlJCT[ON TWO FAMSLY/NEW CONS'71tUCT1iJN O DASEM�N'i' F1NiSi-1 CJ RL7C1F 0 DEC.1� p SIDINC cin �IZE STORiGS 'fYFE OF WORK: CJ NpW I•lOMC CdN�'fftUCTfON C7 ADDIT[ON O MAIN'i�N/4NG�lRE�'Allt d RGMODCLING D�SCRIIIE WORt� II�ING DCENE: ��t!�„�1�,�.;q'ti SI'LEOF IMAfiOVEMGNT LENC7E1 W[T37'1�1 �1 , O FIOUSE C�I�I.Y NUMI3ER p� SQUAItLS ❑ I�lt)USE .k GARAG � �ACF,S PROF05ED S17.E: PROPOSED I�E1Gf IT; St� [?iNG O Vinyl O Atuminum 0 Qiljpr WINryC}WS IN EXISTiNG OPENIN�S �Ycy ONa Olt R41t NGW OPENtNGS�DESCiiIDE CIT.E �F OrEN�Ne Ct•tANCEs �t D ATTA�'l1Ed GARAGE Ci D�TACIIED GARAGE OaoY'lit D Trim O F��:�r•i;a LOCRTIt1N 0t' WINL70W3 Por��rit Na�.; � II�� Receivcd By: �, � 1– ��t��: � �'� � � � ` 1 � �TATENI�`1 'LtP NUMQCR C t'C Y��Q�"�.�pi�L$TATL•�.1 P�� .,) o �rcn�N T�Le 0 KJ1'f IGfL ALL FEES ARE BAS�L1 �N WAI�UA'r'tON, iNCL[71)ING THE CQST O'F (lt ING'1'1•1� X997 U.B.0 FE� SCHEDULE) JOB VALUATION � I_�Ci � OCCUt' 1'iuit Rcviow Firc Surclr�r�;e Surcharg¢ Liccnsc Surchurgc SAC Cli�r&c Curb Cut E�craw Erosion �antrol Park Fcc Scwcr Main �lt:lt'gc 5 � �S _..._ S a � � � � s �� l ,'�— ET f�n�+�M �NT 2CMDL5Et1'VC ,�LIIIMtT: 1. Gx�aanb f'loar i�liu� :, !'rupohc�l llaor }�lan �, Li.r•t o!' yuucturni mcmbcC� t� be uacd F�ft NCW LONSTRUCT1ClN 1NCLU�ING DECKS, ADD1T1�1N5. Pe f'ORCtIES Sl1BMIT: 1. S'itc PinnlSurvey nlyowi�yg t1w �xiKting Ktn�cuires ��nd pron�ye�l �tnjecl. ;' '1'wo xets of co�Lhtruction �flietl� 3. �nC�y C:�ti;�ulat`ioi�.v r•o�z w�rr�aows - r�ov�n� vVA4UE AND MANUFACTUftE STICKER Oht W1NI7UW. MA T 5cc Baek ('�Sc for Fce Schcdulc GS%u of Builcling Pcr►nil Fcc ,Q�l limcs lhc lutal job vnlu.ttiun ,0045 x Pcrmit V:tluaciun Minimunl �S.OU S5,4b (StctlC i.iCenticci ResidCt�4i�l Contr�lclQrw) ,�2230 per SAC il»it (Pians w MWCG for cic�cr►ninut;on) tt+t R= CtxS�S=S 5450 ConKcrvaUion Plan Rcvicw Fec Dctcrmincd' Uy �nginccrin� f1�rCCmCnt nCCChsa�'y ( ) Non Nc:c4ss�ry { ) Muke ch4�eks nuvubtc to: Cttv ni' Fridley Attach TliiS F5 11N APPL,ICATION pOR A P�RM17-NO'f VAL117 UNTIL PROC'CSSGD I hcreby amsiy for a buildin� �cr�nit and I acb�owlcdgc that �hc int�rmation ab�ve is c�mplctc unci uccur�t�; thnt tlic work will bc in confvrr�LU►cc wi�h titc urclinflnecs i�nd ao�ics of dic City of Fridlcy +�nd with thc Minncsou� Consteuction Codcs; �hut 1 uncicr�t��nd �his is not n pernlic but only un appliea[ian for u permit und work i� ttot lo �tart witliout a�crmit ot1 �itc: thal thc wvc'k will bc it� ue�vi�lan �e wilh lhe a��roved plan in tiic c��e oi ci 1 v�orlc wt3icJ � c�uires r�v�cw a��d ap}�rvv�I of plans. •• SICiNA7URC01� �f'I'LICAN'T� �'`L! � __..�'RINTNAME��(�rf��i��7.�/��rC,��, ` !'