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AF - 45870IHINNEGASGO �City of Fridley �T T�e Tov or rwc rwi�t j^` ; r�.---^'- GOMMVNITI' OEVtlO/M[NT OIV, � �i '� MOTCCTIV� N�CTpq CLIT, �l i �-" . i qtt IMLI FMpL{Y �Kt 1._"R./ .. �J N7'fW']NO S ¢ I W h W 6 Y < < ; u �r� MNIYtl 9NIBVB 0 .�,..� � ., roo�d �p '1Nf10J b MNIYO 9 y;� BAYYl sNi�r� 53-�l�-S -915, yl 520 N, E. Glencoe Street T)rake nesigns �INHEGASLO FY�ame 12-16-74 I i --- ��I�I��I� ,�-�f - %��-"-� i I� i ml` c O I', I' i� i `o ! � � c I W i � � CS , � � a� � �a .� � �#��/is' PLUMBIiVf PERt1IT APPLICATIO'iJ "�ri3 r se Res, --- — _ _----- - Plumbin� Fixture Rates: Number Fixturea Future Fixtures New Fixture-Old Open. Catch Bastn Water Heater-99�000 B Ground Run Old Bldg. Elec. Water Heater Gas Fitting Faes: lst 3 Fixtures Additional Fixtures Gas Range-199,000 BTU Reoairs � Alterationa Description� State Surchar¢e �las AVENUc 10,00 N0. RATE TOTAL x $2.00 4 _ X $1.5� x $1.50 x $3.25 TU x $3.00 x $3.25 x $2.00 x $2.00 x $ ,75 1 X $S.00 Jr.00 See �Code g �q°� ��r.cfiarg�] .�0¢ . 50 I TOTAL FEE g 5.yo iThe underaigned hereby makea application for a permit for Che work herein apecified� agreeing to do all work in atrict accordance with the City Ordinancea and rulin of the Department of Buildinge� and hereby declare that a1l�the facte and repzesentations atated in thia application are true and correct. �O�w� oS . (6"�`�''�- Date t � _ - -, � � � � . . � � sueaecr � P R�NO. City of Fridley ° 12704 �� "TT"E`°P°`T"ET"""$ BUILDING PERMIT � � REGEI:PT NO. . ' - CQMMUNITY �EYELOPMENT DIV. � ' . j L """' . � . . .. ... � � r � � - � � PRQTECTIVE INSPECTION: SE0. . � � . � . �. 1 i .. . . .. . , . . F �� "-'1�.� qTY HALL FRIDLE�:. @5432 NUMBER aEV. .DATE � �PAGE . OF nPPROVEO BY �_--_�• ,,, a�s.seo-sasa sio-Fi5 9J5/74 / / }OB ADORESS � �� . 52U Gleneoe 3treet N.E. .1 LEGAL �OTNO. �: � B�OCK � � TRRCTOBADDITION � . . SEEATTACHED oescR. 59,58 i Riverview Heights sHeeT 2 PROPEflTYOWNER� MAILADDPESS � ZIP PHONE � � � �� Drake Designs 7226 Riverdale Road . 3 CQNTPACTOR ��. MAILADORESS � �. ZIP PHONE LICENSENO. S�' 4 ARGHITECTORDESIC�NER � ��MAILADDRESS .� ZIP PHONE LICENSENO. . � $. �NGINfER� �� . MAILADORESS � . � ZIP . �PHONE LICENSENO. � � 8- USEOFBUILDING . � � . � . residential � 7 �-CLA950F WORK �� NEW. ❑ ADDITION ❑ ALTERATION � ❑ REPAIR ❑ . MOVE ❑ REMOVE 8 DESCIi1BEWOHK � . Hcau�e and 12 x 24 garage � .8 � GHANGE pP USE FRObi � . � TO � � � STIPULAFIONS � � . � � � � � � � � Sewer-"Y" 107' West of.M.x. I. Pravide hard surface drive "Y" elv. 847.81 2. Provide vezif�.cation survey Top of footing Min. Elev. 850.81 Inv. Elev. 'of M.H. 849.13 WATER 10' East of Sewer SEPERATE PERi�+tiTS REQEJIRED FQR VYIRIN(i, : HEATING, PCUMBING AND SlGD1S. ' � -� � � TVPEOF�CANST. OCCUPANCYGROUP . OCCUPANCVLOAD � SF.PAAAFE PEFMITS ARE NEOUIRED FOfl ELEGTRICAI PLUMBING, HEATING, f��" .: ' VENTILATING�DR AIfl CONDI710NING. � " . . THIS PERMIT BECOMES.,jIULL AND VOID IF WORK OR CONSiRUCTION ZONING � SQ. FT�� CLL F �� ' �' AUTNQRIiE� IS NOT-COAIMENCED WITHIN BO QAYS, OR IF CONSTflUCTION � � :. ,268. . .2 � 88O � . �� OR� WOflK IS SU57ENDED�Of1 ABANDONED�.FOR A PENIOD.flF 120 DAY3 AT � - � ' ANY ��ME AFTER WOR% 1S COMMENCE0.� � �.. . NO. DWLG UNITS � OFFSTREET PARKING � � - I HEPEBY CfPTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 �' STALLS GARAGES � � ANOKNOWTHESAMET08ETRUEANDCORRECT.AlbPROVI510N50FLAW5 ypWATION SURTA% . .. �AND dflDINANCES GOVERNING TMIS TVPE OF WORK�WILL.$E COMPLIED � � ' � . . WITH WHETHER�SPECiFIEO HEREIN OR NOT. THE GRANTING OF A PERMIT 171-7�`�'t�O 8' 87 � �OE$ NDT P 70�G�YE AUTHORITY 70 VIOLATE OR CANCEL�TME pERMITFEE � � SACCHARGE � ��PROVISIO Of Y OTHER STAiE OR LOCAL LAW REGULATING CON- �: SFflUCT N O HE PE� � NCE CONSTRUCTION. � . - 3%. OO-.�� BOO.00 PLANCHECKFEE TOTALfEE � 6� 345.87 � � 516NATUlSEOFCONFAAL*oROA�UTHOR2EOaGENi IDA Ei WH N P� P L LI Ep NIS IS YOURPERMIT � y: �. � S - 51 �ATUREOFQWNE9tlGOWNERBUIlDER1 iDAiEI WSP � -- O<TEx � . � �2 C> _ � . . � . . APPLICATION FOR RESIDENTIAL, ALTERATION, OR AllllITION BUILDING P�RMIT CITY OF FRIDLEY, DIINNESOTA OWNER'S N2,ME: 1/�A.VC= � Al� BUILDER: �F ADDRESS : �f'j �(� � ��;,�� ADDRES S : .C��t— NO:. �� STREFT: �I 'L�� r'�� LOT: S f BLOCK: � ADDITION: �� vFQVlf�V/ � Elfr�'5�-- / CORNER LOT: INSIDE LOT: %'� SETBACK: �� SIDEYARD: IO IO Applicant aCtach to this form 'hao Certificates of Survey of Lot and proposed building location drawn on these Certificates. To Be Used As: ➢ESCRIPTION OF BUILDING � .� �p�� Front: Q � � Depth: �� - Height: .� � Square Feet: �!� i� Cubic Feet: •{ �, r'' ��,� Front: � �. Depth: � �+ Height: % '� � � Y Square Feet; 7- k� �� Cubic Feet• � ., � .-7 / ,� �' �-1 Type of Construction: `' �` °' ^ C._ Estimated Cost: $ �/� �.. �" To Be Completed: The undersigned hereby makes applicativn for a permit for the work herein specified, agreeing to do all work in stiict accordance with the City o£ Fridley Ordinances and xulings of the Department of Buildings, and hereby declares that all the facts and representatio � ed in this application are true and correct. „ DATE: SIGNATURE: /u Tr. (See Reverse Side For Additional Information � {�...� , �-� '� � , , r� � "� , . A,� � . ; ,�-�-------� � ` ��'5�� 7 �A1f�i�/'•"' J .r- /./( �. �,► , � S t�,, ,�-� �r .�� .� � B. H. BRADLEY � , CIVILENOINSRRNDSURVHYOR �L'YU�. y �pY �}-��,'.. �%P�;�C p�J ,� 3B2B-24TM NVEHUE SOUTH `''� NINNGPoLIY.MMIN860T4Htl� � � ti, � �:'iV�;r ��/e �a?cl� . �.��» i"� -� �� i "� : �' �'�� e e 2 ��, �� ; 50� ..S'tafe 1 " = 2�' p!)eno�e5 p+-operty CorpPrs ,� � � �� z� � �i., a � �� . 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I !' . � � d �` � � � _ , Infiltratiun G;asa �xp wali hct exp_h Int. wal! � Pl�lflg FIQO( Total F3tu. _ �s='� � � � �' , . ,r...�._ .�� .,_..� � ' _ ..., sq. {t. �E.D °R. or sq�ms. �W.A. �' xd� /t/i /L",G�m � Lcngth; Y �IY ws and Doors-Crackage and Area atb Hrl{n( �o. e[ LIr 1[t d � f D we �]1Gfi� I y..R u ? � � r� � � 1 � _�-�. Inhltration � ; _Clau T_ ___ _—_ --r-° 1 -t?- ,?'__ �xp. wa�{ .- ;�, . -":' -_� M1et exp, wali -_ �.� -- 1[¢, w8�� % — -` � �.CI�IT$ � Y' ,. �_..-x Floot ' --� Tota1 Btu i �� s area ' f� �._�_� Requie•d �y,, ft. E.�� ' c. aq. m+ W r�. t.ea�ie nrea �� FI. �'(. Y� aom I L,cngt� Width :, W+ndows and Dours--C�acicage and Aroa __ R'Idt-h—�eli�t �NU cI Llneeiit. (�Artc Na. ui D��e I d� G�y � b6T�s of cn<w ; oy !l/ G�8S! Ezp. wall Titt exp. v lnt. wall rt1�10� _ I I4DY � i�otal 61a. ies. Btu ' '' � tnFlcratiar� � ' 1 ' �� - - -- �-- — ' �_� � � ' �� i �'�lasn 1 �. �;� - - � — ---- -_ �=� 1 -- - — �� r �� wd�� ' 1 i ' —� _ . � -a _ -- ___. '"a _"'�_ __'?'". i�=�: � � hrt exG- wall � �� f _�,,. ;. �� ! �n° wafl ' _-_ _ ,�y� _r.t�,l..._. ; -7--' ; .. - -7 R+ -- -- �: , , i � r:, �-sw . � �� p..__.� ._.r...�.. A�� i �"� y.�� ._ __. ... .'__ .._ _w ..._ �F -1 [ai �lu -:. � . �_�..� �i _Required sq fa E U.R �r sa. ms W A .�eade: ares _ r�ght -� � j 1 F1 '%_�-:ta m i L.cagth .._W�dth ,' Height C; �) Y Winduwe and Doors--{ rackage and Area �— ,—Tµ��d�h THels� � : � I t.. T A en �' o[ + f uRn P�a S .h � � I —+ '� ��-- --�'} � -,'- " I .{ � - � � �- � -� �-=- -� ��-- � -, ,� � � , _ � _� + -- � _� _ __ Btu �� _ -�.- - t _. ; _._ _ d _'. Yf -_._�._ -,,._ _ I; ..� -- _ . .-.} - �-,'t- -r; . �. - � lnh{t>a[ian --� - . . , , , ;,. . ___.. . _ . � � - ----.._ .. ...... .___. ._ .:. T ,._:.. „. . -- � . ,. � 4isse . . �_._ _ .. ._. _ _._'_' � �_ .p.'__...�. . _.__.. _^�T± I�'. �'ap wali ~y ' � i -; _�. , _ -__. .._ --- . _ .7 "t'..__ _, .,.-> r�t .�: ��1i � -__ � _ _� . _ � � Y a _ ___ �� nC wsl;� � I �� --�"4e.�' T . _... � . , _ -.- }�_. _� . .� i � . �IlI. .... :.. ': . � � _ _.�.J�--Y---r...... Y'-..- '.."_ ... _ ; _. i�..�,�.�_�_. :�� . I� � y �' - �_-� _ _ i r-zu -- - - - -- ,-Y' r c � t d .� fi � L�,F � �. .n lY 4 L.eader aren ✓.• _ __ , .., _ __ _ _ __ __� CigEtt � r.�r . . __ ..._ _ _.- _.�.,_. --"' f" � � rl ✓Y,�� _ �r_•�� ;aeagti �� Width� y_ ' i-fe�ght =� �i 4 Windows nnif L�a�ra Cr�c�a¢c and Area � i' - -- r - li ___ _- --- � i , i I �- - -_.. . .._.. . __...� �' Inritr tior ' �� "'� ` _ ___� - . __.__.. . �_L _L.. !-` (,laa =�� I . . _..._. _ __ ` �'- - ----?------` E.zp wali � .�..-- _ -_ ,- �' �I Ntt uE�. wall _. --�__' �.�)` Int wall _ __, _,..--,=_ _...� / �f � L r �in� .. .. __� _ ..� �_.._ _._._ _'.____' ._._"_. P � 100( F�..� _ ..�. .. . ........._ j � �D�d� aiU `.�y._ � � - -'-'- -- j Requuedp. k E.D.R or ,a, ms 14A. •xa .« , �.,,, . :� . P-fd HEAT L055 CALCUtpii�'iN5 DEPAiiTMENT OF ;BUItDINGrS � Weathentrips A.S.Ii.V. . �natmction No. -- - - Guide f we 5I Doors Refvence I Out. Wa11 Int. Wall CeJi�g Roo( oor Kind Yes No ' Y No 19_ ,: /:' - Fl.� l,en th ..�+iVidth ...�.Height 4T .{.J/�(. m l Windowa and Doon—Crackage and Area � Windows and Doors—Cr WIOa❑ Hel6�� Ne. a[ Lfneal ft Area . Witlth Hel`�t No. No. o(ya• Ko�pe.,- i1Bh�• otcreck ea.(t.{ Na �(oane olnane LLel IafiRration � �3'7' Glaie � Exp. wall Net eap. wall Int. wall Ceilmg Floor Toe.l &a. Reauired ia. k. E.D.R. or w. ini. WA. Lesder area Ne. 1 0[� GILN Eup. wall Net e:p. M Int. wall Wideh Area a Araa t q fl. Ar Ceiling �r Floar Total &u. Required aq. ft. E.D.R. or sQ. ina. W.A. l.eader area _ Fl.� Room � Length Width Window� and Doors--CrackaQe and Area Glau . _ Fsp. wali Net exp. watl Int. w�11 Ceiling Floor s � � T Infiltra�ion a F�SL3E,E`a', ie�eiro:z. — - -----_--_ _.-_�-v:_. Ineuiation � Glw 1 fap. wall % �i G'' � '� �= Net e:o, wa11 lnt. wall Ceiling Floor Z- f" � Total &u.. Required W. ft. E.D.R. or �q. int. W.A How � Area � area Fl.! Roam I L.enath Wideh Windowe �nd Doon—Craeluge and Arca Wldth H�I�rt No. o! L�n��l [l. Aro� No. o[ Y�� ot Wn� Il��b o[ er�ek �G. It. �f1�1�i7L110R � Glau Fap. wall Net ezp. wall Int. w�ll Ceiling Floor Total Btu. .R. o� aq. ina. W.A. Leader srea Room I C.ength Width orr—Crackaee end Area No. Btu { � Infiltration Glass Eip. wafl Net eip. wall Int. wall Cei�ing Eloor Total &a Reqwre�";(e E,D.R r aeea .��,�,�:;� . SuB�ECr City of Fridley " � 725g ATTHELOPOfTHETWINS BUILDIN�G PERMIT r ; RECEIPT NO. � � COMMUNITY DEVELOPMENT DIV. p .r � � •� � PROTECTIVE INSPECTION SEQ � � /O / pZ � � � � � � � � /"'� � qTY HALL FRIDLE� 55d32 NUMBER REV. DA1E PAGE OF APPROVEO BV �""'� � ,'� 612-571-3450 9t0-Ft5 9/23/83 � � ��JOBADDRESS 520 Glencoe. Street N.E. . �/ LEGAL � �OTNO. BLOCK � TRACTORADDITION SEEATTACHED , DESCR. 5�6 L . 'Riverview Heights � sHEer . . 2 PROPERTYOWNER MAILAD�RESS ZIP PMONE . � Crai.g Turbak 520 Glencoe Street N.E. 784-9319 . 3. WNTRACTOR .� .MAILADDRESS � ZIP PHONE UCENSE NO. Sartte 4"ARCHITECTORDESIGNER MAIIADDRESS ZIP PMONE LICENSENO. 5 ENGINEER MAILADDRESS ZIP PHONE . LICENSENO. 6 USEOFBUILDING . .� � � Residential 7 CLASSOFWORK �� ❑ NEW ❑ � ADDITION ❑ � ALTERATION ❑ REPAIR ❑ MOVE �O � REMOVE % 8 OESCRBE WORK � Construct Masonry Chimney for Lopi Model #M-52Q Wood Burning Stove �9.CHANGEOFUSEFROM . . TO � STIPULATIONS � �� IC80 #4002 SEPARATEPERMITSARE REDUIHED FOR ELECTRICAL, PLUMBING, NEATING, TYPEOF CONST. OCCUPANCVGROUP OCCUPANCV LOAD VENTILATING OR AIR CONDITIONING. � � THIS PERMIT BECOMES NULL AND VOID IP�WORK OR CONSTRUCTION ZpNING S�.FT. CU.FT. AUTHORIZED IS NOT COMMENCED WITHIN 80-0AYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED POR APERIOD OF 120 DAYS AT � .�ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBV CERTIFY THAT I HAVE FEA� AND EXAMINED THIS APPLICATION SiALLS GARPGES ANDKNOWTHESAMETOBETRUEANOCORFECT.ALLPROVISIONSOFLAWS VALUATION SURTA% . � . AND ORDINANCES.GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO � WITH WNETHER $7ECIFIED HEREIN OR NOT. THE GRANTING OF A PEPMIT $6OO $.SO `DOES NOT PfiESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THE pERMITFEE � SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $TRUCTION OR THE PEFFORMANCE OF CONSTRUCTION. ��.L�S.00 � � PLAN CHECKFEE TOpTALfEE YLS.SQ SiGHaTUREbFCOwiRaCTOnoRaUTNOai2EOaGEH� iUnTE� WHEN PROPERLV ATED THIS IS YOUF PERMIT ' 9-a3-s� 9 � SIGN4T FOWNEAtlfOWNERBUIL�EF� � �DATEi � � BLDG �NS� 0<iE CITY OF FItIDLCY Effective Au9. 1, 1981 APPLICATIO[� FO(t RCS10Ci�TIPw tfUlLD1i�G Pi:f`�i1T5 (Wch•r. Alteratiuns. Additions, or Repairs) OE�HER: CR.p��, -1 '('�ia�4 �� ,�'AK •QUILDER: �� 11DDRE55: �,'�0 9�k.,,..�tr... �. ADDRESS: Il�i�6 {�.E. `c'(1,�li.,..�-�.5� TEL li0: __`1�y -53��q TEL IlO: '15S-N9�ly STItIST N0: L07': Conslruction Location STIiEF.T: BLOQC: )1DAITI02i: Cozncr Lot: Insidc Lot: SctbacY.: Sideyazds: Ap, licv�t attach to t1�is fo:m ta.�o Certificates of Svrvey of lot and p�oposed builcting location dra:+n on eertificates to scale. ��.��,U DESCRIPT10�2 OF CO�JSTRUCTIO�� /n � Front: Depth; Squarc i'eet: dbic Feet: Front: �P�� Height: Heigl�t: Sguare Fect: CUbic Peet: - C�H-rm�c1� Fo2. % i�•pe of Co:.�truction: Estimated Cost: s�Opo _ ��, (�� 7b Be mr.:pleted: ��'�' �"`�Y m� S a0 — Pzoposed Drivmiay tiidth If Nc+r Opening Is Desised: Alt. A Alt. B S S SEC PiVF.R;E SID'c OF StIELT 95ie un�essigned hereb�� mai:ca aPplicltica for a pencit fcz the �:ork he-ein specified, egreein3 to d� .all work iri striet accord�nce Hith the City of Fridle}• Ordi��ances 211(� rulingm of the De��,u cme��t of Bui:dings, and hereby declazes th.�t all the fact� and repre�c�Litiens stated in this applic.:tion aze tzue and cozrect. a�re: q -�3. - $ 3 sicarnzv: : Stipulations: /� ,80 �f�� ,� i� �a � �OU �. .,_ � X NEW ADDN ALTER I1 II I1 CITY OF FRIDLEY 6431 University Ave NE, Fridley, MN 55432 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: �� 1�.�7�lA-�° c�l N� �Y,��r /i�� Legal Description: Owne� Name & Address: �'�� Effective 1/1/2003 (763)572-3604 Bldginsp (763) 571-1287 Fax Tel. # �D�v�°iPl�n -�'��4�8�(9 Contractor: MN LICENSE # Address: Tel. #_ LNWG AREA: GARAGE AREA: Attach to this application, a Cert'rficate of Survey of the tot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. v Length Width Height Sq. Ft. DECK AREA: Length OTHER: Width HgUGround Sq. Ft. Construction Type: Estimated Cost: $ �Driveway Curb Cut Width Needed�0 Ft. +�Ft = _Ft x $ _ $ �a�o � � DATE: 3 �3 APPLICANT: � /.�y H' - Tel. # Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763�71-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surc�arge Curb Cut Escrow Erosion Control $ $ $ $ $ $ Park Fee $, Sewer Main Charge $. TOTAL Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 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 — V - � �� - : .. /� -�R �f� �w�Of�/!�� 2 �,�� Building Inspections 763-572-3604 Tti1S APPLICANT I5: OWNE12/ TENANT MECHANICAL RESIDENTIAL APPLICATION �{�, CITY OF FRIDLEY (D YOUR E-MAIL ADDRESS C� C� ❑ OWNER I}IGONTRACfOR �Nnn�: Cne �'-cA1ko�^ �•��'� (;Ionr��C_ S�" SUBMIT A COPY OF YOUR STA'I'E LICENSE W1TH APPLICATION PERNIIT'I'YPE Tl'PE OR WORK: • I" 1 � � . _ _ �A 1 � � � � � � • STATE PHONE m.Bi�GLE FAMILY ❑'I'�1'0 FAMILY pA1EW L�p£PLACEMENT DETAILED DESCRIPI'ION OF WORK EXP DATE Fnx '11�3-'3'�3—l�tS _ O TON'Nk10USE ❑ ,u.rew.noN�+on�. Permit No.: Received By: Date Rec'd: p1'E ZIP PER MS 16B.665 the permit fee is a minimum of 515.00 or 5% of t6e total cost up to SSDO.OQ whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fuctures. (This should reflect only the cost of labor ) Labor cost under $300 � 515.00. Labor cost between $300 to 5500 = cost of labor x.OS = FOR PROJECfS Wi�RE L°.BOR IXCEEDS 5500, FEES A1tE BASED ON 410.00 PER FIXNRE. EXCEPT Wk1�1� N�TED• �TURES' (WDICA'f� T�T�" NUA�BER OF EACH BELOVn � MODEL:�.�.�1d SI�T� � U,�� Equipment Installed . MFG: � � SIZEBTU MFG . MODEL: MFG � MODEL: SIZF/BTU � �5 � _FIREPLACE (GAS) 515.00 GAS RANGFIOVEN 510.00 AIR TO AIR EXCHANGEER S15 _FIREPLACE (WOOD) 535.00 _NEN' GAS GRILL 510.00 BObER f35.00 � �FURNACE 535.00 GAS UNIT H1Tt EIO.OD CFpT4NEy LiNER SID.OD GAS DRYER SI0.00 POOL HEATER S35.OD DUCTWORKSI0.00 GASPIPINGS1000 —�� ,i� � . ,,Aa-ww u..e .r.+� �.. -._.,..— _.. ..._... . _. . Permit Fee $�_•_ Number of fixtures . _ X •— Surchazge $ .50 Number of fixtures Q$I5.00 _ x$15.00 =$ TOTAL DUE $ _ Number of fixtures Q$25.00 _ x$25.00 =$ Number of fixmres Q S35.OD 1 x$35.00 = S � v� State Surchazge = $ 50 Total = $�b �� THIS IS AN APPLICATIQN FOR A PERMIT NOi VALID VN'fII- PROCESSED � � I hereby apply for a building permit and I acknowledge thaz the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an applicaHo for a permit and work is not to start without a pemilt; that the work will be in accordance with the approved plan in the case of Il w whJ�'_}� rfP�Q"uires review and approval of plans. /f / t, /.�,f/i�I"� '___'.._� I,M� ��/i'Y-f'7.�r/i/ i16TF I�I�SIOY/ SIGNATURE OF APPLICANT City of Fridley Building Inspections Department . 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977