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�uilding BL?ILDING Permit r1o.: � a
I�spe�tions 'RESYDENTIAL APPLICATION Reoei�ed By:(Y _
�63-s�z-36o4 CITY OF FRIDLEY vat��a"�d��"�•'' �' � ���
?63-502-�977 Ft�X EFr�cTTVE �-i-zoio --
D9TE��� �� J "-" � O YOUR E-MAIL ADDRESS
srrE aDD�ss 5 N-7 � �a s-�- l�a n u��. i2 d i/�1 E�—
THIS APPLICANT IS: ❑ QVF'NER ���NTRACTOR
FROPERTY OWNER/ NAME:_ ; 0. r( �C`e i•I-Io A�-E-�
TEN.4,NT �D�ss: S�-I�7 EaS-� 1�anulo..e�Zc�Cr1'Y Fr��_� STATE viiN_ZIP S Sy3,�
PHONE: � CD 3 'Jr % `7 �/ / �
CONTRA.CTOR . NAME: l�.i � r�d o w C o+-��� Q c� '�t' S -
SUBMIT'A COPY OF .
YOUR STATE LICENSE STATE LICENSE #.oiO t�p � y C] EXP DATE �v - 3 I-" I I
�ND CERTIFICATE OF ADDRESS' i Q L. O►'�� O a d S'�. �, CITY 0. C Q STATEM N ZIP 'Jr� I o[ !
INSURAIVCE PHONE ' � O"r.J FAX S I d 5 �
PROPERTY TYPE ❑ E FAM rnrEw rorrs�rxuc�orr srzE
❑ TWO F, LY/NEW CONSTRUCTION STORIES
PERMIT TYPE ❑ avDITT�rr ❑ G�x.aG�S�D ows
� BASEME�IT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ! ❑ SIDING ❑ OTHER
� SW�vIMING POOL
TYPE OF WORK: O NEW HbME CONSTRUCTION ❑ ADDITION
�MAINTENANCE/REPAII2 O REMODELING
DESCRIBE WORK BEING DONE: K.�;n I 0. C.JL p Y`R.. W:� rti c�. O W � r 2.'1C, I S�- 1 Y`� O� h i n-q
a-
SI�E OF IMPROVEMENT LENGTH V4'IDTH HEIGHT S FT
R N ❑ HOUSE ONLY $ASEMENT REi_�ODELING SL1�3MIT
NUMBER OF S��UARES ❑ HOUSE & GAI�AGE L $xisting Floor Plan
� ❑ ATTACIIED Gt�RAGE 2. Proposed floor plan
PF OPOSED S1ZE: ❑ DETACHED G�!.RAGE 3. List of structurat members to be usal
PFOPOSED HEIGHT: �,�p
{� � I I-1 `— FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING O� "'�' � �— ADDITIONS_ & PORCHES SL�MIT•
❑ Vinyl ❑ Tr mt ����� L Site Plan/Survey showing the existing structures
[7 Aluminum
'❑ Other ❑ Fgscia and proposed project:
2. Two sets of consttuction plans
�VINDOWS 3. Energy Calculations
IN EXISTTNG OPENINGS Yes allo LOCATTOIQ OF WINDOWS FOR WIND04VS — PROVIDE U-VALIIE AND
O� FOR NEW OPENINGS�ESCRIBE SIZEEC�F � a��� MANUFACTt)RE STICKER ON WINDOW.
OPENING CHANGES & � n
'IS'PE OF WINDOW TO BE INSTALLED ���JMgER O�' WINDOWS /�-
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING TH� 1997 U.B.0 FEE SGHEDULE)
TQ'TAL JOB VALUATiON $ 0. O � OCCUPANCY TYPE
Permit Fee $ Se� Back Page for Fee S�hedule
Plan Review $ 65'/0 of Building Permit Fee
Fire Surcharge $ .OGl times the total job valuation
Surcharge $" .OGOS x Permit Valuation Minimum $5.00
License Surcharge $': �.G� $5 .00 (State Licensed Residential Contractors)
SAC Charge $' $2lOQ per SAC Unit (Plans to MWCC for determination)
Cnrb Cut Escrow $; $+ 6 ft= ft x$24 =$
Eiosion CantroT $ $430 Conservation Plan Review
PGrk Fee $; Fe� Determined by Engineering
Sewer Main Charge $' Agreement necessary O Non Necessary O
Total bue $� 3 Mxke checks a able toc Ci of Fridle Attach Sti ulations
THIS IS AN APPLICATION FO�t A PERMIT-NOT VALID UNTIL PROCESSED
I iereby apply for a building permi� and I acknowledge that the information above is compl�te and accurate; that the w�ork will be in
canformance with the ordinances andi codes of the City of Fridl��y and with the Minnesota Construction Codes,• that I understand this is not a�
�rermit but only an applucation for a permit and work is not to start without a permit on site; that the work will be in accordance with the
agproved plan in the cas� of a 1 work w'c equires �eview and prov f plans..1 /�
SIIrNATURE OF APPLICAr'T RIN ME JvQ YL C y SG� yry� i c�S f��A� � pC. � —
A.F'PROVAL INSPECTOR SI:�NATURE , /