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P - 43561OCT-13-2011 07:13 n ui� k�l�tg Insp+�ctior�s ��3-���-3�a4 763-��2-�977 F.AX srr�adb��ss,�, 'P1�1TS q�i,ICAN"C- IC '1'ENANT SUFII`+IIT A CpPY OF YO�11� �TATB LICL�iSE AND �R'CIFICATE OP 1�TSURANCB AM STANDARD WATER CONTRdL T63 537 IS82 S� I3 U.LLl]1N(ir �ermit �vo.�b����� �+ SIDLr'NTIA►,L AP'PL�CA�'IUN Received By; C��"� OF �'+ RIDL�+ Y �at��l�jdi� ��� �o� �-�au�, CIOWNER '�ONTRACTGYt STA'!'6 LICLN$E 5[NQLE FAM1L�'/N'BW CdN3TRUCTION 'tWQ FAMiLY/NEW C�NSTRUCTIAN � &IS�NT FlPiIBH Q RC50F O TS�CK �I SIDIlV4 � ��T Nun��a.N�19�T� �1� 310 w �CTfY �_STATEN� FAX ° �J " SI7.E? ST'ORIBS � L7 WIDiUOWS 1�'DRAIN TlLB � OTt�R TYFE U$ WiIRK: 0 NEW xi01u�'s CDNSTRUC110N 0 ADDI7YON � 1NAIN'CBN'Al�CElit8PA1R G REMODEiiN(} I�RCR�A WORK BEIN(3 DOI�TE; %"1 3iZE OE.1MP'ROVLh�NT ,,. 1.�aNG'rH -- - ,,..` d HOUSE Ol�t,'Y 4r• SQ�t7ARES �_. 0 �dUSE � QAAAG�; O ATTACFIED CrARAGB �0�0 SIZE; 1� �1BTACFIED QAItAGE P'R�PObfiD HGIOH'P: �„_ !� Vinyl � a�rnn,� � ()thw ._ fN�Ci �BI��TGS C7Yes �No OR F(�Ii �113W OPENINGS DP„SCRIHE 5IZE OF OPENII�} CF�AN(iE3 � Pesmit �ee Plan R�view �ire�� arge Lioens� surcharge 3AC CA�tge Cwrb Cut Escrvw Eroaioii Con�l Parlc F� Sawer IV1ain Charge �ASED oso�� 0 Tdm p Feecia LQCA'170N OF WIN1�UVV5 � 1997 YJ.B.0 FF,E SCHEDULE) i, E,�tlstlngFloorPfqn 2. Pr�pp�d Soot plen 3. List of stivctua�t rnembcie to I�a uetd FUii NEW CONS17tUCTlON INCit]Dit�C� DEC�CS, Dnrr�o�rs � �1 �; 1. slfa �stdsmveY shv�g' tht cxioti�g stiucau�es and Proi�oaed �s'ole�ct, Z. Two sats of sOnluuctiou plm�e FOI� WII�OWS — PRO'V'� U-VALUE AND M�►NE7FACTURB 3'FICKER ON W�i1�pW. 'I'ERIALS: � i� G.� � L-J- -- See Back Page for Fee Schedule S 65°ib of Building Permit Fee $ .001 tin�es the total job valu�tion � .0005 x Permit'Valuation Minimtttn �S,t?p S �{ $3A0 (StaGe LicBnsed Residential Contrectvrsj � �� 52290 par SAC Unit (Plans ta MWGC for determination) S� ti+6ft° ftxS25�$ S , ,,,,, �450 Canatsrvadon Plan Review � - -- - Fx Detetmined by EnB��'�8 � _ � Agreement necesearY () Non Necessa�Y i) 'rT;15 i9 AN AAPLICATI�II+Y ppR A PERMiT•NO't' vAI.ID UNTII. PiiOCHS�SD Y lurek�' aPPly for s b„ilding permit snd i aclmowledge thet the ir�formation above is complet�s and eccurets; tisat tl�e work wil] be in canfarti�e�nce with the ordlnences a�nd oode� af the City of Fridley and with the Minncsata Conslruction Codes; th�t � understand t�ia ie nat a permit t3ut only sn applicatian for a permit and worlr ie not to start without a permit on sioe, that the work wiIi be in eccardane� with th� eppro�etl plan in the ca�e of w ui�es n.wiew �d approval of p�. STGNA7'�3RE OF APPY.ICANT �, PRIN'I' NAME '�QQ�j� �����" DATE �/ APPAO�AI. 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