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AF - 45895� � � City of Fridley, Minn� BUILDING PERMIT L"�ss b N� 6378 net�: ��' _.��__��_.._._—�_ ow,ter: �� ' . —_ aailaer _._.. --...._ .... _ ..._........_.._........._......._.._.._..._..._._._ Addtxes.�.._._...._,._._—..__.—,._..._.._._........_...._._.._..._.._ Address _.:__._..—_...�....._........_........._......._....__.._...._.._...__....._ Na �.,l�� .... 54cet .. .._ ._ . .. _ ...__..t� ..�..r ��Part .. Lot.W...L��.(a.._ Block ._......_ ._. ... Additlon or Sugb-Div3s� ...���'! ,/�..__. _. �.._. Corner.Lot ---.._.._.�__ Inaide Lot ._......�...... Setback ..c�_�.__..._.... Sideyard �.�'i�Cyc'L?i�S,1 Foundation IIevation DESCRIPTION OF BUILDING v,ea . q/ �J q bp� �J Front sC"�SP._ DePth s.3��� - HeiBht -of-� . S9. Ft �C�..O� Gii. Ft �.�.�J_..�o ..^..�_...�,.�._.--- Fmn ---� . DePth __._�� 8eight .__.�Sq. Ft. ._.._..__.......... Cu. Ft. _..._..—'--- Type of C�structlon ....���1_�_�_.. Est CoSt .�l_��_ e,� ___...... To be Coznpleted _........__...._._.._...__.-.--- In conaideration oY the 3ssuance W me of a permit to conshvet the building described above, I agree W do the propoaed work in acrnrdance wit6 the description abov� Porth ia comp'ance with all provisions of ordinancea of the city of FYidley. � G�r'L�7 In cansfderatfon of the pa,yment of a fee of P�t is herebY 6ranted to._`—._..._..-- to conatruct the buflding or addition as described above. Th1s permit is granted upon the express conditlon that the person to whom it is g�anted and his agents, employees and workmen, in all work �done in, around and upon seid building or any part thereof, shall conform in all respects to the ordinances of FridleY, bLnnesota regaiding locatiay c�struction, alteration, maintenance, repair and moving of bulldings within the dty ]Imits and th3a pa�tnit mqy be revoked at aqy Ume upon violatlon of any of the prov�aions of aaid ordinancea � _ � � Buildin6 �P�to�' • � NOTICE Thb p��M dsa nef sewr IM supnaMa�. IrhMNw tar wielnW P�n+btn6. f� M�4+f. aw�e x wM�r. M wn fe w 1M lolldYO M�wr fer wpvM+ pxehs for 1Mw N�m. � " �" � . , APPLICATION FOR BUILDING PBRMIT CITY OF FRIDLEY� MINNE30T6 Oanera Name � /'�%i�c/�'S2�i� Huilder,��;/�SJ`.G`•f' M.�'�'//�'/�-5'L•r,� . Addresa /�3�0 ��ei/,t�t!� ��,.t/o%- lktdress (�FU ('�U/.�/�'�'S7�A/i� •. ; ; _ � LOCATFON OF BUILDING ' No. ��� 3tree� � E/CO/_' Part of Lot Lot � S��, � Block y Addition or �b.Div, �f'/l�i�%�i'�.�ki %!�/ �/�T� cor� �t x�a�.a� �t t% set ��x 3s—' ssae—�a a` l<i, 3�Eft ELEVATION `— FOUNDATION F�TATION Applicani attach to this form Certificate of 5urveq of Lot and proposed bvilding location. DESCRIPTION OF BUiIDING To be used ae: SL,ra,tE ,Qw.�eu_,_ l�ont a2/o Depth �.� Height �.d sq. Ft. 9k� cu. �t. /� 7/_ � Fiont Depth Height Sq. Ft. Cu. Ft. Type of Construction, f/f�if /N�� F Estimat,ed Cost��� �� Tc te coag�letea /�a D ��f' The u�dersigtbed hereby mekes apglication £or a permit for the work herein apecified, sgreeing to do all work in etriat accordsttce with the City Ordinances and ruling oY the Department of Buildings, and hereby declarea that e11 the facts and repreaenta- tions atated in thia app2ication are true and corre .' DATE /19ifiS'CiS% �°���,� SIGNATi7RE ' � �G�-�+_z�� (A Sohedula of Fee costa can be £ound on the Raverae 3ids.) ��� � . . + �+ �I , ,. .� . _ _ �.ti� � L i� �� i; ��� � I March 7, 1963 Mr. Cheoter L. Maciaszek b380 Quincy Street N. B. Fsidley 21, Minneeota &e; SS5 Glencx Street N. E. pnar Sir: I don"t ls.�ow what impreaaion you have of our Bullding Inspectioxa Department, Qulte obvious, it io not very good. You �o nce tell your aab-aontractora to bui13 a base- meat 8 feet fr�� µ?� 1 ��� s ;�_ c��y a��erific wa!v�r �:a�w t:� :i�ex� �.'. 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Construction No. insulation Guide ( ` Windows Doors Reference I Out. Wall Int Wall Ceiling Roof Floor I Kind How Yes—No Yea—No 19_ Room Length � Width `/� Neight Fl.� Room L.ength /(o Width Windows ors—Cracksge and Area Windows and Doors—Craekage and Area Width Helght No. o[ Llneaf [<. Area Widt� Heig�t No. o[ Llneal f0. Are¢ No. o[ pane o[ Dane lighb a� crack ap, tL No. o[ D%�e o[ pane Ilehta ot crnek W. [[. � �o '7- / � R- � /6 2 �- d' /% y a � i � � ° 6 8 Coef. Bm Infiltration 3 6 0 o In6ltration �� Glass ° u Glau f6 E7[p. Wel� Net exp. wall ! o 0 Int. wall Ceiling Floor � / Total Bta o � Required sq. h. E.D.R. or aq. ins. W.A. I.eader arca Room Length t/ Width 6 Heig6t �' Windows and Doora--Craekage and Area Wtd[R Helgnt No.of I.iveallt. Area Na ot yane a[ oane Ilghts o[ crack ea. ft. � /6 � /� i7 Coef. Btu . Infiltration /� f�b �� O �� ! SO � S O Exp. wall �� Net exp. wall 3/ /d i o Int. wall . Required aq. ft. E.D.R. or aq. ins. W.A. l.eader arca � I.� �,.,F,��Room �Length Width �Vindows and Doora--Crackage and Area Wldth Halgpl No. ot L(peal f0. Area Na. of Dane a[ ynne It{�ts a[ crack eq. ft. 9 'J.P //_ �_ ZA // Infiltration Glasa ExP. wall Net exp. w int. wall Ceiling Floor Total Btu. � L,eader arca 9�o I'� %U Bm // a O �B o �oa o /�'/ O � � d Eap. wa{I Net ezp. wall Int. wall Ceiling �.� �a /�d �e �a o i� //a � fotal titu. 0 5 0 Required aq. ft. E.D.R. or sq. ins. W.A. L.eader area /�F'I.I Room � l.ength %�. Width Height Windowa and Doora—Czaekage and Area Wld[h 8elght No. ot Llneal tt Area No. ot D�ne of pnne 116�te oi creck ec. tt. 1 �46 � 2 i6 i6 Glaa� Exp. wall Net eap. � Int. wall Ceiling F{oor Totd� BtU. eq. ft. E.D.R. or sq. ins. W.A. Leader area om I L.ength �`Width va and Doon--Craelcage and Area dth Helt�t No. o[ L1nea1 f[. Ares �ne otp�ve Ilg�b oI e�ack �Q. [t. i /� z /6 io p / 6 '� / �/ � a 6 Z o ( { � s!G o "� o 0 o � 6b S '� 2 G lnh�trahon �/ 9 � 6 Pj Class ,`3 � Exp. wall � Net exp. wall �'t� 0 3 O G Int. wall Ceiling Floor q�- i sl� S Total Btu. S �s Requued aq, ft. E.D.R. or sq. ins. W.A. Leader area _; � v� r-1 � 1 � � � fh � � � � t, ; � � O U � �� C�_7 � n � z 0 Q�A a t^ :T � � � � � � � � � � � � � U � � •�4 6 \ Y K kw 00 3a O �' o '� a 9 oe 4 � _ ° .a 7 x 6� 0 9 U .kF�. Y ,y �' 'C � Y i�a 3ip3" 5 ���5��_ €3b� a �, a a ��v� ;�s �E�� 0 4 � � J ���� a � m y 7 a kY � y.� � °3 �q '� T � y .� bb�� s a w ���� � `0 uo � d.e°� �6�� : W L = < i 3 V • Z • . S'�NIN300 3�NYY N7 l�dY sv� tYKVM ou�v s�nw NJlh SNIVIO YOOV � tunoa 1 � A � i A a V � �iI ro � ti �' � � N � D M N O v �N O " � o �p R y Ci L • :°. °: ° � E u � o � o � ` � � v �o � E S�C � F° '� ie Q W � u�: g � NyYM �IS ynM 4 9 � Yo M1M � TIYMIII� (g � saistro • �` wv�. � i sa{maS� Q� K e'oI �j �` •t I m .. .rl n .�i . + I W J � 0 W U � � F"� � J � a a� 6 � � o� i z � � 9 .� p � O 0 z° c � G � 5 a z 4� - .a I a o � � o k. I i F q N �1 K M N N N M 4 g� Si, Nt+J gt� o3 8�C 8� n g�p Q y K W r! V! � N� h N �B % X x % x % X k 71 % � � -! � ! � I .! z ( I I I • • • • � • • • • ! : : ' ' $ ,� . : . . . . m . . . . m � � �, : : � M . � i � V . . � W.=g:°a� �., F . „ . g '= M C�c ' 7 a�y. � 9� IC .. .� . �y « � K � X `� O • � C � 00 u �i •�+ D'��y X �..C. .y � e W � p t- � x� u c+y w x'm a C�� �" �� c7 `�t c! �" a w ' 3 .`. 6 z "' � � z� z u 3 zq F�<� 0y0 �+ b � d � .� U 7 N N A � � ,°r, °o t°r� � l.f� II� t . � , �� rl'. • �' 'S �,:. O �• «�; . : �: � H• e� ' � o .�t ° � � � a � O � � � R s � � N Q � N U � � � � � $UBJECT � � c�ty of F��a��y ATTHEj�POP.THE.TNlINS �. BUILD�NW PER�IT� ` CQMMUNITY.OEVEIOPMENT OIY. . � . . � RECEIPfiiJ� � � PROTECTIVE�INSPfCTIONSEC. - . (��D�' �"'1 � pTY HALL Ffi10LE� 55432 MUMBER REV. OAtE' vace oF avvqovED Br ' `•J �6f238�3450 � 910-f15 � � 4/25/73 �oe aooaess 555 Glencoe Street N,E. 1 IEGAL LOTNO. BLOCK TRACTORADOITION DESCR. Z.�S,26 H Riverview Heights Addition 2 PNOPEPTYOWNER MA7LA�ORESS - Z�P Gerald Lucas 555 Glencoe Street N.E. 3 CONTRAC70R � � MAILADDRESS � . Z�P Suasel Company, 1850 Como Avenue, St. Paul 4 ARCHITECTOROESIGNER �M.AILADDHESS Z�p �� 8 SEEATTACHED SHEET �, LICENSE NO. Dwelling 7� CLASSOFWORK - � � Qi NEW � � ❑ ADDITION ❑ ALTERATION � � ❑ REPAIR ❑ MOVE ❑ REMOVE B OESCRI6EWOAK � Conetruct 16' x 22' Gatage �Detached) a STIPULA710NS. � � � � . �� Prwide a hard suxfaee driveway , Gaxage is to be 3'6" from back lot line. SEPE[iATE PERMtTS 4tE(,���EfT FOR WlRRNG, HEATINC. Pf,.E�t�tf�i�G �6� �EG�dS. 9EPARATE PERMITSARE:REQUIRED fOR ELECTRICAL, PLUMBING, HEATWG, VENTILA7ING OR AIP CONDITIONING, � THIS�PERMtT BECAMfS NULI AWD VOID IF�� WORK OR CONSTRUCTION AUTHORIZEO IS NOT COMMENCE� WITHIN 60 DAVS, OR lF CONSTRUCTION OR. WORN IS SUSPENDED OFl ABANDONED FOR��A�PERI00 OF 720 OAYS AT ANV TIME.AFTER WORK IS COMMENCED. .. . �� I.kEREBY CERTIFY THAT I MAVE AEAD AND EXAMiNED THIS APPLICATION AN�KNOWTHESAMETOBETRUEANDCORRECT.ALLPROVISIONSOFLAWS ANO OHDINANCES GOVERNING THIS 7YPE QF WORK WILL BE COMPUED WITH WHETMER SVECIFtED HBREW.OP� NOT. THE�.G.RANTING OF A PERMIT DOES NOT pRESUME TO.GiVB AU7HOHITV.TO VIOLATE OR CANCEL 7NE PROYIS�ONS OF ANY OTHER STATE OR L6CAL LAW REOULATING CON- 57RUCTION OR THE PERFOHMANCE OF GONSTRUCTION�. �� . � �,�� � - �,�.o�.�.� $IGNATUAEOiCONTRACTOR . AUiH 2EOAGEWT IOqTEI R�1 352 OWLG. UNITS� � OFFSTREET � � STALLS � � G ATION SURTAX 1 595.00 .80 IITFEE SACCHARGF �Z,�O ,CHECKfEE TOTALfEE� $�.8� FT. ssao AP.P�iCATIQN AQA RE$IABNTIA�. ALT�R,ATION, OR AAAITIaN �UILDING P�RMIT G�TY OF FRTA��Y, MINN�SQTA QW�IR&' $ NA31E : l�e. c/�1 ,C �� a s SUYLDER : � �� s�� ADp�lESS : ys-��"Z,/a.� c o 2 S f N E. ADDiiESS : /�Sa c oY,.� o A..e -�-f (�._.f.Q �Uts,., ��._-.,�--.._ 8T&S�Tt �,Q�F 5-��._ iAT: ���2� BLOCK� � ADAITIONZ ltCi �F�J� �` �-� y��/G.�! iS SQ&N�R Lqf i �IAIS L(YI: ` SBTBACRt SIDEY�IRD: .,.....-...---... �i.ia8qt ;atGach ta Ch�,s €+pCq�,a Certifioatea of Su_ sveY of Lot and proppaed bqti,i$�A$ lACatloxt dtJpiR OA t�la�! Ce3cti£1�ltese � ��SCRIPTIAN OF BUILDING �b � Ufed As: +�e�nc�o�. �o_o--m�+�.. /� gT�ik7 2 �— i1�+th• /e � AC�t. Squaure Fest; �j �_Cabie. P�efi3 s��� Front• 1lepth• Haight:�,.,,,_� Squaxa i�eet; Cubic Feeti c /,5 f5 �� oi GonWtructiops F>Q��«- $atieosted Coat: $ � !o Aa Qowpiqtedo , po � � � Zbp tup�s'�igaed hereby awkea a�licstirnt for, a peXmit £ar the wp;k hsrein ;pe�sxlled„ agseairrg to do all Noik ia sttiat aacosdance with the Ci1ty o:E FRttd��t O�'d7.Pastces qad 2u1371�� �� ��PBx�°C 4f Bui,ldi�8, q�d beiebY i�p3.asAeap � all Lhe #�acts aqd sepreeentaCione sxated j,n thia applicatfaa s� tsue ap�d avszect, . A#17�; Je -� a S- �s� � SIGt�ATOgB: �9�f" � �� �v�'6�m�--� (Bq Rsv4ses S#de Fo= Add�tiunal InPosaatioa,) � r�, �8 0 � � '� S° � ;� ��_ � � �.. � �.���...� ✓ l� . � �1 � � �=hTi � �� _ �� lIINMCAI`�1L1411\:LN:�II� � 1 1 1 �Y � '�' : � -` �� +:� �.o cK . ` .�,: _. � ,«�� � y j � �,,,: , h..� �"�.� -rJ' prei/MS.*�.. .il� _ � �" : � . �R � . . � NALD H. DCUTSCH `' � `T',i %i nk:-.; .:. ' � nFna r,iiriv�.vrw ; . � . . � Mirn.i.t3 . .�. u��i .t . 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'r., ? + �� .,�":� ��' .'.cc.ca Cui,aty, '.::a.�o.�i.a, ao 5us-voyod by ma tne 221d nay o, w�,,,;ch, I�; -0 ' � �an.s�� t� . �� CL. - � i ,�""° " y� ;. t ,, �t: 't � _ __ _ _ _ - — ._ - -�- . �-..�:... ,�-k�.«-,II..�.-„-�� �,.a. :s�.-��..�.;x�•�s ,. � �._ _ , , � WORK ORDER ` J THE SUSSEL CE'?: - -78y-S't7o - i850 COMO AVE. ST. PAUL NAME ���A/ 1� L UC�IS p}{pN�� CAII: 645-0331 �OB ADDRESS ��S �L�� ca� C�/1�C �Pcrmit bV-� �s�4-- � � �i lijt F� S� . �� . . �, ❑ Legal Oesn iption HLi)G C64E AREA . . a � . c �. � `�LQI n SALESMAN S�TTEp��CONTRACTOATE SIZE�6X�i � ❑ e,� � ' aadd.� �°° v� w � ± � ��S p FOR OFPICE USE ONLY � Tylpe Const F RA �'fE CONTRACTOR '� " ° ��B °� � Z � �� Slab: ❑ In �By Sussel . SUSSEI JOB # 5G GONTRACT = � 2 � i-d z �� � ❑ By Owner Approx. � �� � 2SYARTINGSPOINTSONLY ' � � � � P � �� � � � � � . i L / 3� S.P4. S.S.P.I. '. �� - R.P.L. . . . � . .. . /�O V SE .. ... r, Alley �. ' � . {�� �.. .. . . ..�... .. . � House. - F, Svice.t � � � . �� � � � . . � � � . Other . . �. . . . . � � � � � � . � . �. . . � .... , . . . . . _ . .. ' � � SQUare With �'U�t � . . . . . . � . . .. . . . : . '} �i�'O[�S . . . .. . ' f1%' .. �. . . .. � �e � Mesh . � � . . � . �. . , . . . . . � ` jA Sod fiem. � By C .�_ � . . . . . . . . ... : � � � . � , � . ,... : . . . _ ._. , ' C� 6�Bag Mix � n�T.�..+m� a . . . . I /�5�� .. .�yi—� C� �'F` . . . ' ($'No Ta i '}'n p ' . ' � . . Si A.B.U�A '!'C��^�� � 1�y Gre e oint � .. I . A ... �� (Z �.� /�/ _ .... . �9 ? k�CONDUIT ' �� � � - �3 � �� � �.�. � �i., �+ � � PQ O.H. Dr. Offset ? � . . � . �J�-�S�.�0.���l��ocatioa ��E" � . � � .GOhDV�T . . . . p�p�TIFY OBY OW�1CI C�BV SUSSI`I . �, .. � � � �Windows I RAP1C11 '�.) y Existing gaFa9c: No � � �. . .. . . � .. . . . .. . ❑ Detacned �Attached Ves ❑ � � � Size of existin9�— .. x — . �. . � . .. � .. .z � / . . .. Existing garage will 6e: � � �� , � � - � � - � � � � � ' ❑ Left as is L�GHT P,,RLe� �5 ❑ Converted to LS. - By owner �, � �� . � � . . � � ' � Removed By`. Owner,p�'i � � ��N�St� ' � � . # Sussel f 1 �1•� C01.1G2ECE - � Junk Musf Se Removed BV Owne� '., � � � . . � : �� � � � � � . .. v . . y . . .. . . �.w� � ., . � . � � . . . . . . . ._ .. . � : O.Specify other removals by Sus- - . �. __ .... '- Sel or owne� � trecs, 6ushes, etc � �� � � � � � � y � ��Q� t � " ; � Show approx, dist. garage to � �� � ' � � _ar .— �,r.-- . —� — — � house and all prop. lines ��� � - � � � � � � � � � v � � � � Stakes visible - f. � Yes '�`_l No � � �� � � � � � � . „ Survey avaifable - L7 Yes ❑ N . � � � � � . �_ . �I �i Special instructions from./ 3� { 6�--� �; owner. L IGdI i 1� '���— _ '�j gRuSN FrA1�CH ;� �ti/ <'t_ ia R S � � _ � .-' / ` � . PART OF C�NTRAC7.N �, J 6 ? I 3 �. . . �. . .. _ . . . �.. . . _ . � . . . . . . � .. . � : �OtneGSepfE,__ . P-4 flEV.� � . . . . . � soeicc* P City of Fridley �) � � � 5 �� AT THE TOP OF THE TWINS gU ILDING PERMIT RECEIPT NO � ��__.__�_ COMMUNITV DEVELOPMENT �IV. +� r � PROTECTIVE WSPECTION SEL. 3J3 �'G � ../ `..-.� �'°I,'/ CITY HALL FRIDLE� 55432 MUMBER REV �4TE VPGE OF pVCqDVED BV ` i 612-571-3450 9i0-F75 7/12/96 / / JOBADDRE55 555 Glencoe Street NE 1 LEGAL �OTNO. BLOCK TRACTOAADDITION SEEATTACMED DESCH. '2S�'lb H Riverview Heights sMeer � 2 PHOPERTYOWNER MAILADDPES$ ZIP PNONE Allen Hoffer 555 Glencoe Street NE 782-1b56 3 CONTRACTOR MAILADDFESS ZIP � GHONE LICENSENO. Same 4 ARCHITECT OR DESIGNER MAIL A�DRESS ZIP PHONE LICENSE NO 5 ENGINEER MAiLA�DRESS ZIP PHONE L�CENSENO. 6 USE OG BUILDING Residential 7 CLASSOFWORK - ❑ NEW ❑ ADDITION O ALTERATION L] REPAfR ❑ MOVE O FEMOVE R 8 OESCRIBEWORK Reroof House (15 Sq) Tear—off 9 CHANGEOFUSEFti�M TO STIPULATIONS Underlayment must comply with the State Building Code. iYPEOFGON$T. OCCUVANCYGROUP OCCUPANCVLOAD SEPARATE VERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMe1NG, NEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO.FT. CU.FL. AUTMORIZED IS NOT COMMENCED WITHIN 60 DAVS, OR IF CONSTRUCTION OR WORK I$ SUSPENDED OR ABANDONED FOR A PEPIO� OF 120 OAYS AT ANY TIME AFiEP WORK IS COMMENCE�. NO. DWLG. UNITS OFFSTFEET PAPNING I NEREBY CERTIFV THAT 1 HAVE REAO ANO E%AMINED TNIS APPLIGATION 1 STALLS GARAGES ANOKNOWTHESAMETOBETRUEANDCORRECT.ALLPROVISIONSOflAWS VA�UATION SURTA% AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMP�IED @ WITH WHETNER SPEGFIE� HEPEIN OR NOT. TNE GRANTING OF A PEHMIT �1az37 W.6Z �OES NOT PRESUME TO GIVE AUTMOHITY LO VIOLATE OR CANCEI THE pERMITFEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING GON- @ @ STRUCTION OR THE VERF4FMANCE OF CONSTfiUCT10N. y��i.3.00 Fire ucC. yrl.Z�i PLANCHECKFEE TOTALFEE . $44.86 seHnruaeO�cor+'aac*oaOAA�iwou�zeoacemr i a�E� WMEN PqOPERIV LIDnTED �HIS IS VOUP PEAMIT � p c IGNaTUAE FO A���OWNfRBWLDER� �D E� BLOG�NS� �S-� NEW ADDN ALTER [l Il [] CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Effective 3/1/96 ConsiructionAddress: .S� ��J,,.��y.� f'�" /�/� Legai Description: Owner Name & Address: �J%�i�/ ,�%��'C%Z Tel. #�p �i jr� Contractor: MN LICENSE # Address: r.ft �„e�„.L.� .�T N E Tel. # LIVING AREA: GARAGE AREA: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. I.ength Length DESCRIPTION OF IMPROVEMENT DECI{ AREA: Length OTi�R: %� �' Comer Lot [ J Inside Lot [] Ft. Yd Setback Tyge of Construcrion: Approx. Completion Date: _ Width Width Width Height Sq. Ft. Height Sq. Ft. Hgt/Ground _ Sq. Ft. Side Yard Setbacks Fstimated Cost: $ %_ 2 �7• � , (Cost on Back) Driveway b t Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: / APPLICANT: G2�.�.. ��-C� Tel. #`7PT J�.� . Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Fscrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ 3 `Q' $ .Z $ � �OZ $ $ $ $ $ $ � l� CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuarion (1/lOth%) $.50/$1,(10� Valuation $900 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Deternvned by Engineering Agreement Necessary [] Not Necessary [ j �