P - 36717Building
I�aspe�tions
763-572�3604
763-502-4977 FAX
DATE lll�"�1�t
SITE ADARESS �
tHI5 APpT.,CCANT IS:
TENAN�'
SUB14lIT A COp'Y OP
YOUR STATE LICENSE
AND CLRTIF[CAY'E OF
INSURANC�
��t)�'�RTY TYPE
TYPE OF WORYC:
n�SCCti�l� wORK BE[NG
BITILDZIVG
RESID�N'TYAL AFFLICAT�ON
C�TX C��' FRIDLEY
�iECT1VE 7-1-201 D
YOUR E-MA1L ADD1i�SS __ Qli t C_ 1
'r'Yl D1^r
❑ OWNF�i
annx�ss:� E 5�a.i r man� c�-,�,�;
PHONfi: ��'I03�� —�3��,�J
SiA7�E
�VtVE L 1�2 "►`l�d"" V7�.� "1'
STNOLB FAMI4Y/1VBW CONST[tUCT[ON
TWp F.4MtLYlNEW CONSTRUC'�ON
O BASEMFM FlNCSH '�O OF
O DECK 'O SIDMii
O NEW HOMB CON�TRUCfION
O MAINTENANCTs/REPAIR
� 0 HOUSE ONLY
NUMB�R OF SQUARBS � .�i0U3B � C}ARAGB
� as �Aa'rACHSA GAI�AGB
PKOF45ED SIZB� Q DBTAC[�1] GARAG$
PROPOSED FffitikTl',
SI�ING
❑ 'V'Inyl
❑ Aluminum
❑ QWer��
Vv��DO�v6
1N EiL�3T1Nd4P�lIN[QS �Yes ❑Nn
OR iORNE�Vi+OPElVIN03•DESCRIHE StZE OF
OPENCNQ Ci�ANI�ES �
TYPE OF WlNbOW TO HE iN3TaLLEb
►�
���il BCV��i+
Fire 3uraharge
Sura6aig�
L'eccens� Sw�charge
SAC Charge
Curb Cut �scrow
Eroaian Cocmol
Park Fee
Scwer Maia t;�arge
�►RE �ASEb ON
S
S
❑So�ii
❑ Tnm
nf�u
LOCATiON OF W1NbOW3
FermitNa.;�� (V� 2t'��
Raceived B�r
���dU��� 2Q1
sxPnA,T/S����3131� �411
�' Y�d .�]di CTfY 1^i!'lOIC_A�— STA7'�ZtP �
Fa�c t.,.'�P.�; '�-1 a —i $�
SIZE
ST�WSS
E�n a w�Nnows
O DRAtN TILH
� OTEIPR
i !'OOL
ADDITION
RBMODELIN4
�� ►..��. -- � t�'3��� �C..
W1UT'H HE1G[iT �'C
$�e°b'I�S�Lf RSMOD&L1Nd SUB(K[T:
2 , �dns Floor Plan
3. L�9 trucfiaa! m�nb�s to be ased
NUMSER OF WII�IDQWS
,C�ATION, riVCY.YJDiIYC TH� COS7 t)�'
N'G� TT�Y� 1497 CJ.�.� �`EE SGHEI�ULE)
. . ire��+i�w
PO�e N�VV CQN$7AUCTicyri 1NCLUD1TtCf DBCKS,
anDtitONa__ � PORrxrRC �� SMIi-
1. Sim P1an13►�etvey ulicnwing d�e qetatin�g �ucdues
end �oposed proJeat.
a. rwo seta of oor�nuet;on plu�a
a. snergy calwtatlana
FOR WIIaDU1Y3 — FROVIllfi U•VALUB AND
MANUFAC717RE S'TICK&R �N 1NIIVDQW.
654� of Building permit �ce
,001 times the total job v�luation
.4005 x Pem,it Valuation Minimum $5.00
55.00 {State Licensed Residential Cantxacttns)
S210p per SAC U'nit (P1ans to M�VCC for detenninadon)
B+6 fl=�ftx S24=S
5450 C'anservetiarn Piare Review
Pee De�ermined by Engineerin8
a�ee�nt n«�ssa*r t? rron xac�s�y ()
MAke che� payai�e tb: Cliv ot FtWlev Alt�e
TiII3 IS AN APPLiCATfdN FOR A PERWIIT NOT YAL[D UNTIL PRL)CBSSED •
I hereby a�gly for a building permit an�d I aclmowledge rt,at the infa�matian above is complate and accurau; that the work will be in
conformanc::� with t}ae o�ances and codes oi the City of Fridley and with the Min�esota Construction Codes; tl:at I undersl�d tl�is �S not a
parmit but only an application for a permit and work is not to start withaut a pennit on site; that the work wiill be in acoordance with the
s�gproved plan in the case ofj�1 L warkv� h�ich requires r�vitw and �provel of y��(j ! /
SIttNATUREOFAPPLICANT JC\ � : _ �1'N.�_ PRINTNAMBp�Jt 1�,—`il.�--DATE �! �A 1 �:�L�_
APpRQV L IN3PECTOR SIGNATURE —T ''r--
��� r t�.�,,c..�c � t ti.�.p �m�� �r:�aa� � c`5�h c�. c.h.+�E.�. �
Wd Z£�8£�Z 060Zl6L/66 �a3�a £/L :a��d S£86 Z6L £9L :�o��