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AF - 42550City of Fridley, Minn. 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERMIT Date: ._._I�ec.emh�x.._26.,._]�.Z2 Owner: _._._...._Darrel A�._ Farr_ .De_v_elopmentW Co • Builder _._ Sac�e_.�..._. Address --.----•--5-3-0.1._.Hr.o_ok1�sL..BauleSZ.ax.d._._..__.------� Address .__S.am�e.� �� �1857 - LOCATION OF BUILDING No. ..------�5.6.-�.---....... Street .._....��.t_.._�.y.�xi.a.u.._P��S.._J�..E.�._.___.._.___.. Part of Lot Lot ..............2----..._._._._._. Block .----.------.2-----------•----.-----------.---- Addition or Sub-Division __..TnnShrtick �,r.th-_.T-.H.- 3rA ,�rlr1; tion Corner Lot __.- .............-------- Inside Lot .-_--....--_--X--:__--.----._ Setback _.__._.._.._________ Sideyard Sewer Elevation ---------------------------------•--_--...----------------------------------_ Foundation Elevation _.. DESCRIPTION OF BUILbING To be Used as: 1200' _T.o�7.nh:t�u.�e..-----------.._ Front _..._...Z_4. � . Depth ._.._..2.� � Height,. _..26. �___.. Sq. Ft. _._51LQ � .� Ca. Ft ..Z�y.,CZRp � _.Ga.�age--------•--•-- ..........:.. Front ....1.Q...S � Depth __..22_� Hei�ht __._.1D'_-• Sq. Ft. ...._231 � Cu. Ft. ._._..2.�..3,10 � Type of Gonstruction ._.__TnIQ�?sl:...Ex�me.______. Est. Cost�._._�2.Q}Q1Q . To be Completed ��Par Stipulations : � ���� C� - � In consideration of the issuance to me of a permit to construct the buiIding described above, I agree to do 'the proposed work in accordance with the description abo}re-'se� forth and in compliance wj,th all provisions ot Orclir►ances of Lhe city of Fridley. � / � 1/ 10 . O1 Sr£�ate In consideration of the payment of a fee of $_._38i.4(L_.__., permit is hereby granied io Darrel A. Farr Deve1. _�........___.__....._._ ...............................__ to construct the building or addition as described above, This pexmii is granted upo�t the express condition that the person to whom it is granted and his agents, employees and workmen, in. all work done in, around and upon said building, or any part thereof, shall conform in all respeCts •to the ordinBnceS Of �'ridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of btsilding� yyithin the city limits and this permit may be revoked ' e upon ' la ion of ai�y of the provisions of said o�rdinances. -__ c��-� Buildin$ Inspector D L CLARK NOTICE: This permif does not eover the eonstruetion, installafion for wiring, plumbing, gas heating, sewer or watsr. Bs sun to sN ths Building Inspectar for separate permits for theae items. - ' �1 � A :. A � r1P�LICATIQN � OR RESIDEiv'TIAL, AL�'rK.ATION, OR AllllI'�'IO�; BUILDING �'��I�1I"I' CITY OF FRIDLEY, i`-SINNESOT�, �',���' 5 NA:� : D,��-rA/ .� F�ar,� /.,rar/�. C'o. BUiLDu:t : S� a�re �. r�DD�SS : cS9�/ .�/'�odtly» �/ud • ADT���^S : s�t an E�,. r�4 :. SSb / s�E� : .�l.%r� ��i u�s-�i Qe' f c� sS IA'T ; Z BLOCK: 'Z ADDITi0�7 ° �.+�/7NJ�a.�+c� /Vo���s T. /}'. �„g^r�J�,c%/i ��o �'i CJ�'T� L�: Ii�SIDG i.OT: 6� 5�3Bs�L�: S�Dx,I'Fu�z____'_x„�„ ���li�aitt a�tach to this fo�n �o �Q.�ti`icat�� o� Su�v�y O:� I,4i ancl pro��s9a buil.ding loc�tion drawn ozi ��Z��� ���tifi�atos. ,�o Il2 Uaed As : �sa✓rr d� �u3� �ESCRIPTIOi� OF BUILDI�;G �ront: .Z'°�. �J��h, �,��v /.Z � G� S.iva�� ��ar_: le�ta Cubic ��st: �' �.��b� �� " ���o��: /�,a�' �up��: .�-� � Sq3�axe ; a�� ; .�o / i N: zg�t; .�� ,,r.5°� � a � Hazgi � • /�> � Gubic i���• .�,�/a i.�P° oi �onst;uc�ion: .�L%�� .�s°°�.��. �;s��ti�d 1;���: � ,!� �O1e�;�.�� }- �o �� ����.���a: 7—/— 73 �'t1� L'Il�.��i;>3�;12C� 'S1�T?'�Jj7 1�3�:C?8 �Z�(7j.�.b3�1IIX1 �O� 3 i)�.'�"'�l?.i �U�' ``x�lY 6JO��zC 'S?t":�3;n SF3�Ca.�i�?�y ,'�..di�..'8�?7� �O 'ZJ r;�� T7U?"LC 1a1 a';;��'��i t!CL:O'�:3;1Cu Y;�L�:i 'i,:i:,'. !�',?'u� Cl"� �'L�.1':_��;� fl��'c?inance� and �.al-!n.�� o� �h° L�e���� �t o:: :�uil��_i .;.3, -,�� �n -.��y dzcl�.'.��a tn�� ail �.�s� i�v��3 ,-°.nri x�����s�n4a�ions si�:��-��i �-s: �1��:3 �pp? ��a�:;,an rMrn ��12 BZli� COX'�°C�:, ; ��T "�, . /.Z — .t G „ .,,, ,;,. - 7 Z �?�. :t_;..J?."s ,° G . (S �> � �?�1���� Si�A x or „#�d�.� ��:na'! ��io:c-^ac:Laa , ) :� � �� . City of Fridley r ar TN2 TOP OR rNE TwINi , i` . 1 rL-'�-^-� GONw�NITY OEV��.p�MENT OIV, � 't � MmECTrvR wt�CrpN p�rr, `� i r-- ; prr +�►u r�e�Ot,Rr �iNt 1..._..11.� �.� N�-sw-a�s0 Job Address ' �� Catntractor_ of Building etion Date '' � I � I i ', ( u - � ;_ � Wf i � ' � �� `�<�!^ � � 3 "I i ( I a�Nra+ � i - i sv�i I I '1ddY � `�1� I - 4Y'I I Y , r � ; •�s wl I � I i ; i •sao� I '�narval I � I � i i I %�SNISYB� ( � HJ1V�I I iDd k: � . !Q p e►+iraal� ( � � aoo�� o� w=. ( O o I saaMOHSI ( � I �,� � tl •iNnoa� I � HN�aa � p'� sAVai� �� I I q� ►+srM - � S)INIS� I � � sN�sr� �ani M1YY �ivNiyn tl71YM) I � 1 • I i Q i � � ���� � to G .� O w � '�a+ F+i � � � a� � � � � � . . �����"� aLUM�i��r, PERf1IT QPPLICATI���� Da�_f.y:�t�.��' u�+ yt[��� se ss Phone s .. _ Phone � i7/I T--- — -- __ _—__ ___ __ _ ----- -- - -_ _----- �f Plumbing Fixture Rates: N0. RATE TOTAL I! Number Fixtures r0 x$2.00 0?$ p.�v ±� Future Fixtures x $1.50 � �' New Fixture-Old Open. x $1.50 Catch Basin x $3.25 �� Water Heater-99,000 BTU / x $3.00 �'.cIC� ! Ground Run Old Bldg. x 3.25 . $ � Elec. Water Heater x$2.00 ' j Gas Fitting Fees; i lst 3 Fixtures �- / x$2.00 �?. C17) - —� Additional Fixtures x $ .75 I' Gas Range-199,000 BTU x$5.00 ! ; ! Ret�airs & Alterations , ( ^ See � � Description: Code iState Surchart�e .SO i i TOTAL FEE $ d�SZ} !The undersigned hereby makea application for a permit �fpr the work herein specified� agreeing to do all work in strict accordanca w ith the City Qrdinances and rulin of the Department of Buildinga,� and hereby declare that a1l�the tacta and repxesentations atated in this applieation are true and corxect. �'—� "�3 'Signature Date � . d'„� t � August 16, 1973 Lee Blectsic 3775 North Higkiway #52 Sobbinedale� Minnesota 53422 Res Yl�trical Permit 8hortaga� Dear Sirr: \ Tha following ia due for the electrical parmite for the following add� Each addreso will raquira e saparate affadavit. 5561; 3563, 5365, 5567 Eaet Bavarian Pue N.B. Sesnice Ais Cond. Disposal Diehwaehas Furnace 4a arlac. 17 Sxket� $ 6.00 4.25 3.00 3.00 4.00 io.so 4.00 $34.75 Amoun� Paid 16.00 AMOIJNT D[TH P08 SACH UNIT �18.75 � , 5571� 5573, 5575. 5577 8a�c Savasian Pas� N.E. At�PUQNT DtfB FOA BACI� i1NIT $34.75 � r, 5576; SS78, 5580� 5582 East Bavarian Pa�s N.H. d1�DlJNT DITS POR EACS UNTT $18.75 We will axpacc theae pesmits in our offica in the neut 10 days. $incarely, LBONARD EICt�fILLBB Electrical Inspactor LS/mh � � -� � E�closed must have been sent to us in errox. 560-3450 . State Board of �lectricity ' ��'�� e � 6431 UNIVERSITY AVENUE NE Lee Electric 3775 North Highway ��52 Robbinsdale, Minnesota 55422 Dear Sirs: ANOKA COUNTY August 16, 1973 FRIDLEY, 55421 � _ � ^ . - �. +�. � ,� =i � '� �� ;.::: ���{!:��� _.. ::� -�`7 qU�,13�' , 4� �CEf F���i:;,, 3 ��• �� i; � - -- ' � ; .., i �:�;-r�--,: '.� �� . Re: Electrical Permit Shortages The following is due for the electrical permits for the following addresses. Each address will require a separate affadavit. C5561 �563 5565 567 F�ast Bavarian Pass N.E. L..7�/da� � LY,�/67� �a�6���a�6qJ Service $ 6.00 Air Cond. 4.25 Disposal 3.00 Dishwasher 3.00 Furnace 4.00 42 Outlets 10.50 17 Sockets 4.00 $34.75 Amount Paid 16,00 ���-yv-.� CH,_iTNIT $18.75 5571, 5573, 5575, 5577 East Bavarian Pass N.E.�^\ AMOUNT DUE FOR EACH UNIT $34.75 J3� R.�ttiJ Ow i _ ' Da�� NiaY( �.�•'. .,.._.�__...___ � ' �!�-'-='i';?� �.t� � ,,;� r, � , . . ...� � � _��� _ _ i � � -----.___� � '.. -- - - � _. , � ��%5'�0 :-� . 7s,a a � . f--7�w°y_ j -..._..1 5576, 5578 5580 5582 ast Bavarian Pass N.E. ��"'7�/�� C�'7a�6{ (� 7�/ C.� ��z/66 � � �'D-`-3 _: AM�NT DU F�R CH UNIT $18.75 ��S�a � e will expect these permits in our office in the next 10 days. Sincerely, LE/mh � � � ` �';n Cx t C� � � 1� 1�t � } < < L ���.-) LEONARD EICHMILLER Electrica2 Inspector i��CAf;011 ��''I�1! � H�OI�Ig, CO�OI�li4, Y!M'f�01'�OA� RlI�ONOO �d � �:OIN�Ol1� S�lfMK OIN� �l11'�CK P�►R�r�1. R,4TE SCHEDULE a�v*rx ar�►urc 1►rn: �ura mrxr.. llisnace she2i dE Duet Worrc ... ilo.00 i Replacensent af Plirnace 6.00 � Repairs de Altcrati.ons--up to =500.00 g.pp =_ ___ _- Repairs & Alteratlon� e�ch add. f:i00.OQ . 3� �__ . _._ _ �fLC.N. WJ�111[ AI1t llusiace Shelt � Ihtrt Wark to 170,000 BTU e� add. AO,OOQ B'PIJ . . . . . _ . . Repltce� of i�rnace Repairs & Alterations--up to �500.00 Repairs dc A2tesations each add. =SOO.OQ . E10 00 t� 1 D, � 3.QU = 6.00 t 6.OU �_. 3.00 ;___ __ _ S'L'EAlI o: itOT WATER SYST£![ Ftirnace 5he2I 3c Lines-to 400 sq. .*t. f.DR Steam �lO.�JO �--- -_ _._ i�rnace Shc�tt ���e,-to 640 �q. ft. EDR Fiot Water 20.00 s_ __ __-__ __ Each add. Z0� aq. tt. EDR Ste�m 3.(Nl =_ -.--. Each add. 320 sq. ft. EDR Hot Water 3.00 a�______ OIL BIIRKER-to 3 gal per hour g,pp ;_____ __ over 3 ga1. per hour-See r'ee Schedule _ c� avnx�x ��v ta �,aou sTin a.oa =.�-. � o�r is�.000 aTV a.� F« s��. GAS FITTIPC FEi�: It0 RATE TOTAL I st 3 l�xtares x� 20� t-=�-°'-v Add'etlotrai Tixtures ____ x 9Q i--- -- Gss Rao�e tu 190.000 :i S.OQ� S _ � a r� as�.rn� sts�a�t �E�Ti�.i,tt�i lT�T� �.�aa.rFC�s t �xn�s R�S Fi[uc4 /07 - / % - � 5� t--- sw PN fe6�d� �G/���vt,ai � l � • G`d zcrr�r. rs� � ��. � "�,,,�// .�D n.�. � B�aq., rT,o.,. seo-�eo � ��- . _-:.. ti .� City oi �idley: The undersigned hereby makes application for a permit !or the work herei�: spec►fied, agreeing to do ai1 work in strict aceordnnce with the Gity Ordinaneet� and ruling of the Departm�nt of Buildings, and hereby declares that aI} the fac!€ and representatiuns stated in this application are true and cOrteet. F?�idleY. Minn_----- ------y,l� � Owner --_L -��1L�.� � - --�i ,Lk ,�tv°� Kind of Building ..� � tJsed ac - - - ��'�-��i�� --- - . To be completed about _ _ -- -- _ - --- _ � Estimated Coct, S _ f�.*-� - --- ---------- Uld-New. Buiiding Permit No. _-_ P•rm►t No._ J��Q � D�EfCAIPTi01� OF VIO1lR iiEATTNG or PO'WL�R PLAN'P�-$team, got Water� Warm Air-No � _ n,,� Trade Ivamr� -�-�--� g� �/D le 3-// �1 Capacity---�I_� �t-- SQ. !t E.D.R BTU $,p Total Connected I,o�d 1(ind o! �1x BURNEI2 - Trade Na•r+e g� � C�D�►b� &l. !t E.D R- B'1'tT g� (�MARKL-OMtR} �,�.� � ���A _ �r � � ���� �� su�iors rre.. � �� / � �'/G3G SUBJECT - P "�F�����' City of Fridley 2 2 0 6 8 ' , AT THE TOP OF THE TWINS g U I L D I N G P E R M I T RE • r � �• COMMUNITY OEVELOPMENT DtV. i ; V ����� , 11< < 1 � r � � PROTECTIVE INSPECTION SEC. ( � /"'1 � CITY HALL FRIOLEV 55432 NUMBER REV. DATE PAGE Of ACPROVED BY �""�"� ,'� 612-571-3450 910-F15 8/26/93 / / J08 ADDRESS 5561 East Bavarian Pass NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 2 Innsbruck North Townhouse 3rd Addn SHEET 2 PROPERTY OWNEF MAIL ADDRESS 21P PHONE James Jeska 3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO. Dicks Fire & Storm 864 19 Ave SE, Minneapolis MM[�II 55414 781^6170 2481 d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE IICENSE NO. 6 USE OF BUILDING Residential 7 CIASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION G� REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Rerao� Garage (.Tear�-c���) 9 CHANGEOFUSEFROM TO STIPULATIONS �rovide smoke.dete.ctors as per UBC 1210 adjacent to all sleeping areas and in basement. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIF CONDITIONING. 7HIS PERMIT BECOMES NULL AND VOID IF WOFK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR 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 �- STALLS GARAGES AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $4HQ.00 $.SO WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON- $1S.00 5+48 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTA� FEE License 5C $5.00 $20,98 S�GNAIURE OF CONTRACTOA OR AUTHORIZED AGENT IDATEi WHE P EFiLY IOATED THIS IS YOUR ERMI � � SiGNATURE OF OWNER iiF OWNER BUILDERi IDATE� LD � �' TE NEW ADDN ALTER t� Ll [l Construction Address: � Legal Descriptiom: � CTTY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application .� East Bavarian Pass NE Effective 5/26193 �-�`��f Owner Name 8c Address: Tel. # Contractor: Dicks Fire & storm (,Richard J. williams> MN LICENSE � 24s1 A�t'eSS: 864 19 Ave SE, Minneapolis , MN 55414 Tel. # 781--6170 Attach to this appticatioa, a Ceitificate of Survey of the 3 � s- a s so lot, with the proposed construction drawn on it to scaie. DESCRIPTXUN OF iMPROVEMENT LI�ING AREA: L.ength Width Height Sq. Ft. GARAGE AREA: Length Widtte Height Sq. Ft. DECK AREA: Length - Width Hgt/Ground Sq. Ft. OTHER: Reroof Garage j�� f�� � t)�� ` Corner Lot [) Inside Lot [] Ft. Yd Setback Type of Construction: Approx. Completion Date: Side Yard Setfiacks Fstimaied Cost: � �/ �o =� . (Cost an Back) Driveway Curb Cut t�Vidth Needed: Ft. + 6 Ft = Ft x� _$ DATE: 81261�3 APPLICANT: ��_,r� ���z..— Tel. #�sl-6i�o Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escraw Erosion Control Park Fee Sewer Main Charge TOTAL ' 1 �� $ Fee Schedule on Reverse 5ide $ .001 of Permit Valuation (1 / lOth %) $ $.SO/$1,000 Valua6on $ $750 per SAC Unit $ $S.QO (State Licen�d Residential Contractors) $ Alt. "A" or Alt. "B" Above $ Conservation Plan Review $450.00 $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ) $ STIPULATIOI�S: - r ' e sue�etT P City of Fridley 3068 AT THE TOP OF THE TWINS g � I L D I N G P E R M I T r � ` RECEIPT NO. � ` COMMUNITV OEVELOPMENT DIV. ��� � y • � PNOTECTIVE INSPECTION SEC. r , , � � �"'1 � CITY NALL fR10LE� 55132 NUMBEP nEV O�iE P�GE Oi �VVnOVEO Br �""�"� �'' 612-571-3450 910-F15 2/24/00 � � �oenooaess 563-5565-5567 East Bavarian Pass NE t IEGAL LOT NO. BLOCK TRACT OR AODITION SEE ATTACHEO DESCR. 1,2,3,4 2 Innsbruck North Townhouse 3rd Addn SHEET 2 PFOPEfiTY OWNER MAIL ADDRESS 21P PMONE Various 3 CON7RACTOR MAIL ADDRESS ZIP PHONE LICENSE NO North Central Builders Inc 7401 42 Ave N, New Hope, MN 55427 533-6168 3763 � ARCHITECT OR DESIGNER MAIL AODRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL AODRESS 21P PHONE IICENSE NO 6 USE OF BUIlO1NG Townhouse Building 7 CLASS OF WORK ❑ NEW O ADDITION � ALTERATION C�} REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Reside 4 Unit Townhouse Building 9 CHANGE OF USE FROM TO STIPU�ATIONS Call for building wrap before covering. 7YPE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD SEPARATE PERMITS ARE fiEOUIRED fOR EIECTR�CAL, PLUMBING, MEATING. VENTILATING OR AIR CONDITIONING TMIS PERMIT BECOMES NULL AND VOID IF WOfiK OR CONSTRUCTION ZONING SQ. fT CU FT AUTHOF12E0 IS NOT COMMENCED N�ITHIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENOEO OR ABANDONEO FOR A PERIOD OF /20 OAYS AT ANV TIME AFTEfi WORK IS COMMENCED. NO DWIG. UNITS OffSTREET PARKING I HEREBY CERTIfV THAT 1 HAVE FEAD ANO EXAMINEO THI$ APPLICATION �F STALLS GARAGES AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PFOVISIONS OF LAWS VAlUAT10N SURTAX ANO ORDINANCES GOVERNING TNIS TVPE OF WORK WILL 9E COMPUED � 18 � 79� $g , 4O WIThi WMETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PFESUME TO GIVE AUTHORITY TO VIOLATE OF CANCEL THE pEqMITfEE SACCNARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULAT�NG CON- $307.25 Fir SC �LH.HO STRUCTiON OA ?ME PERFOfiMANCE Of CONSTRUCTION PLAN CHECK FEE TOT L, EE Z�zy ferr Lice C $5 $340.45 S�GNATUAEO�C �•CTOQOA• THOR�ZEO�GENT IDATEi ME P P VALIOA THIS IS VOUR PERMIT � � �� �'� S�GNaTUAE O� OWNEA��F OWNEABUI�DEQi IDATE� Bl �NS� � ���tF NEW j ] ADDN [ l ALTER [ ] Construction Address Legal Description: _ Effective 5/10/99 S 7a — � �c��- CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 ���3 I I� �1( UQf Sl�� N� BUII.DING PERMIT APPLICATION �� / SS �3 a, _ �y� G�G� 551oI-b3-�OS b�l E. �VPR1�N hSS Owner Name & Address: Tel. # Contractor: �,O R7 N C�NT RAL QJL�I I L D ERS � i NG . MN LICEN� E 3 7�03 A d dress: ` � �} � j �- i �. Y_1�.� �V�. N� � E.� N H d p� , M N� 5� 2% Tel. � 3 3- b I b� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: •� � . Length Length Length I�ESCIR�'1'ION OF Ily.LP�nVEM�NT Width Width Width Height Height Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: �E - S I D I N G "� �R �►� Estimated Cost: $��,�Gj'� , � D Driveway Curb Cut Width Needed: DATE: `�°�.1 �j Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Ft. + 6 Ft = �D`%��� � ����. $ ��•� , $ ,. �'l� . $ � �� $ $ $ $ Ft x $ �$ Te1. ��l�) 533-b � b8 Fee Schedule on Reverse Side .001 of Pernut Valuation (1/lOth%) $.50/$1,000 Valuation $1050 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 [ ] � $ ` ��a,y�