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AF - 46188BUILDING PERMIT Village of Fridley, Minn. N� 2 5 4 7 Date .`%:�:.�^.".`..Q.�! ....................... f Owner ��''�`�f' ��'�' .. Builder �.. :Y .. . . .. . .. . . ............. .. ............ Address �<�,.� (� . . . .'�-,��,,,,,,,.�; . GLx.. , . .. , , , Address LOCATION OF BUfLDING No. .�. f�....... . Street �,-2.�F�as., e�-.n . . .......... .. . . ... Part of Lot . . . .... . . ....... . . .... . Lot .....$ .... .... Block . . .3.... . ..... Addition or Sub-Division �.:'f,/�. ,;�i/�L,G�[%. ...�J.4#�!:axj::� . Corner Lot ... ...... Inside Lot ........ /� � ' . y� .... Setback �J•.�. SideYaz'dIO•�•I%.C�F� .............. To be Used as: � , i: � ` ,'✓•rL�t.���: j/�..... i .................... DESCRIPTION OF BUILDiNG Front ,f'�:.. . Depth .,;,� €:�. . . Height . ra..� .�_ . Front ........ Depth ........ Heignt ......... Sq. F`t � 4 .�.E`�. Cu. Ft. . . . .. .. . Sq. Ft. . ....... Cu. Ft. ... ..... Type ot Construction . : - EG� _ . � ��.xy,.t,.�.. Est. Cos .r%�c�f�•��........... To be Completed a�,:.�,E,�'7s6&.a.. In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the village of Fridley. � ................................................... consideration of ffie payment of a fee of $ �t permit is hernby granted �to �.�f�...... ..... •?,y: ..... to construct the build�dr addition as described above. This permit is granted upon e re ndihon that the person to whom it is granted and his agents, employees and worl¢nen, in all work done in, azound and upon said building, or any part thereof, shall conform in al] respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the village limiYS and this permit may be revoked at any tune upon violation of any of the provisions of said ordinances. _ .. .. Building Inspector NOTICE: This permit does not cover the constr4ction, installation ar alteration for wiring, plumbing, gas heat(ng, sewer or water. Be sure to see the 8ui7ding lnspector for separate permits for these items. � sue�ec* PE NO. City of Fridley o �gg59 ATTHE70POFTHETWINS gUILDING PERI�IIT ' � ' - RECEIP � � � . �L COMMUNITY DEVELOPMENT �IV. t� r i ' PROTECTIVE INSPECTION SEC. 3 a�9 � I � i � ' /°'1 � CITV MALL FRIDIE� 55�32 NUMBEP AEV. D�TF V>GE OF APPqOVEO BY ,""� � �'� 612-571-3450 9i0-Fi5 6/16/89 / / JOB ADDRESS 5811 Hackmann Avenue N.E. 1 LE�AL �OTNO. � BLOCK TRACTORADOITION SEEATTACHED oesca. g 3 Parkview Manor SHEET 2 PROPERTYOWNER MAILADDRE55 ZIP PHONE Drago & Julie Flores 5811 Hackmann Avenue N.E. 571-4409 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO. Same d ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO. 5 ENGINEER MAILADDPESS ZIP PMONE UCENSENO. 6 USE OF BUILDING ' Residential 7 CLASSOFWORK p NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE S DESCRIBE WORK . Install patio door 9 CHANGE OF USE FROM TO STIPUiATIONS See notations on plan TYPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD SEPAFATE PERMITS ARE REOU�RED FOR ELECTRICAL, PLUMBING. HEATING, VENTILATING OR AIR CONDITIONING. TMIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ.FT. CU.FT. AUTHORI2ED IS NOT COMMENCED WITHIN 80 �AYS, OR If CONSTRUCTION OR WORK IS SUSPENDEO OR ABANDONED FOR A PEflIOD O: 120 DAVS AT ANV TIME AFTER WOPK IS COMMENCEO. � NO. DWIG. UNITS OFFSTREET PARKING I HEREBV CERTiFV THAT I HAVE READ ANO E%AMINED THI$ APPLICATION 1 STALLS GAPAGES ANDKNOWTHESAMETOBETflUEANOCORRECT.ALLPROVISIONSOFLAWS yp�UATION SURTAX AND ORDINANCES GOVERNING TMIS �YPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED l/EREIN OR NOT. THE GRANTING OF A PEHMIT �3SO $. SO �OES NOT PRESUME 10 GIVE AUTNORIiV TO VIOLATE OR CANCEL TIiE pERMITFEE SACCMARGE PROVISIONS OF ANY OTMER STATE OR LOCAL LAW REGULATING CON� STRUCTION OR TME PERFORMANCE OF CONSTRUCTION. $I.S.00 FLAN CHECKFEE TOTALFEE $15�5� S�GNnTUREO�COrvrnaG*ppOaa�iHOa2EDnGErv* iDaiE� � r WHEN PROPERIY VA ATED THIS IS vOUR PERMIT S�GN�TUREOFOWNERUFOWNEPBNLDER� iOATF BLDG ��+SP niE I�1 [ ) Effec�tive 5/1/88 1�DnJ [ ] R-1 AND R-2 AL'PER [ ] Buildi.ttg Feimit Applicatian � ���, s� �: 5 � ► � l�A� ►� � n A U . �1 G � �� � � � Iegal nescsiptian: l.o� � �� C IL '7 "{� ►'� iL- l�c v � C�w '-`�t72 owner xame & Aaa,�a: �cw�-c,� g Jv..t- ��c�ic,s �. # 5 7! �! u o� Oontractox': � � Tel. � " " �: � � � — Attach to this applicaticn, a Oertificate of Sluvey of the lot, with the pnopoEed omstructim �awn on it to scale. u�>::r� �VM1�, �r �.�.:h'1+.�=J LIQII�1Ci IIREA: Ie�gth Width Gi4RAL� 11I�'1,: Iesfgth Width D�C�C 11RSn: Ierx�th Wiri}h O'1'�R: 'S1.1`�j � R 6 �1°h Heic�t Sq. Ft. iieic�t Sq. Ft. ik�t/�aad _ ScI. Ft. Oorner Iat [xj Inside Iat [] Ft. Yd Setback Side Yazsi Setbacks Zype of oar�sttucti�• Fstimated oost: S �� 3 5� P.pprox. OcaQletion Uate• J�l l, '3 � Proposed D�iveway Width If New Opening Is Desis+ed: Ft. S $ n�: 6 f� � `� t�Mrcqo R- � n.� + 6r rn�.�# � � l� �l V��j b (� �c�,xr: �t � State S�nc3�a�e � � $ Driveway Fscrow $ Park Fee S Sewer Main Q�arge $ . �. �TT�: �5 !!G'��: $ �5�50 «4� � _, . � Fee ��,�e an Reve�.se side $.50/$1,000 Valuatian $575 per SAC Unit Alt. °A° or Alt. °B^ Above Fee D�etetmined by ffix�ineerir►g ��YII ��Y[J � �, J -- - - _ __ _ - - ____ ---- _ � , ; � � ��'�"� � � � __ _ __ ��dt� � J�l �f� > (�c? T ` _ _ - _ __ �., , oP ,t��,���� � �`' ° �t � � �r _ _ - �'` `� _. Z� `� �A'� _ o� ___ _ _ � �� �'°"� _ T�,�D��" _ _ _ __ c -- ti � r � �.. s�e,cc* PERMIT NO. City of Fridley ��,� � 4� ATTHETOPOFTHETWINS gUILDiNG PERMIT � � GEIP � � L __ COMMUNI�Y OEVELOPMENT OIV r ��' PROTELTNE INSPECTION SEG. � I,., ( � � u/ � � � NUMBfN MEY D�TE VPGF O� /�P Y � i-°� • CITY HALL FRIOLE� 55a92 i""' � • •'� 612-571-3450 9t0-F15 / / JOB AODRESS 5811 HACKMANN AVE NE 1 LEGAL ��TNO. BLOCK THACTORADDIiION SEEATTACHEO DESCH. $ 3 PARRVIEW MANOR SNEET 2 PHOVERTVOWNEF MAILADOHES$ 21P PHONE ------------ KEN COLE 5811 HACKMANN AVE NE FRIDLEY MN 55432 571-9371 3 CONTRACTOR MAIL ADORESS Z�P PHONE LICENSE NO B�e1H$_--- $APiE d AFCHITECTORDESiGNER MAILA��RESS ZIP VHONE LICENSENO. 5 ENGINEER MAILAODHESS I�P �NONE LICENSENO 6 USEOFBUILDING RESIDENTIAL 7 CLASSOFWOHK � ❑ NEW ❑ ADDITION ❑ AITERATION � REPAIR ❑ MOVE O REMOVE 8 DESCRiBEWORK REROOF TEAR—OFF (19Sq) 9 CHANGE OF USE FPOM T� STIPULATIONS UNDERLAYMENT MUST COMPLY WITH THE STATE BUILDING CODES. TYPEOFCONST. OCCUPANCYGNOUG OCCUPANCV�OAO SEPARFTE PERMITS ARE RE�UIRED FOR ELECTRICAL. PLUMBING. HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULI AND VOID IF WORK OR CONSTRUCTION ZONING SO.FT. CU.FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 12p DAVS AT ANV TIME AFTER WORK IS COMMENCED. N0. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFV THAT I MAVE READ AND E%AMINE� iH15 APPLICATION STALLS GARAGES AND KNOW TME SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS yp�UATION SURTAX ANO ORDINANCES GOVERNING TMIS TVPE OF WORN WILL BE COMPLIED 1520.00 .76 WITM WHETHER SPE IFIED HEREIN OR NOT. THE GRANTING OF A PEqM1T DOES NOT PqESUME TO GIVE AU HITV TO VIOLATE OR CANCEI TME pEPMITFEE SACCHAHGE GROVISIONS OF AN OTHER T E R LOCAL LAW qEGVIATING CON- SI•SO ZRE SC I.SZ STRUCTION OF i GE FO E F CONSTRUCTION P�AN CMECKfEE TOTqLFEE . Q S bi.�a SiGUn* e ovc * Ac 0 oAnu*MOa¢EOncEH* �oai WHEN PFOPE VA� ATED THIS IS YOUR PERMIT S�GNOTpaEO�OWNEPi��OWrvEPBU4DEAi iD�TEi B� �NS� ' �+�-� ! �i " ADDN ALTER t � �l �) Const�uctionAddress: Legal Description: _ Owner Name 8c Address: Contractor: Address: CITY OF FR[DLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application S� 11 l��,U�r.�n � Ave NL- � Effective 8/1/95 Tel. Ak�N)5�1 -�3�1�r�)7S�a��lo MN LICENSE # Attach to tlris application, a Ceriifcabe of Survey of the lot, with the proposed conslruction drawn on it to scale. LIVING AREA: Lengt6 GARAGE AREA: Length DEC% AREA: Len OTHER: j Pc✓ �c�-�` DESCRIPTION OF IMPROVSMENT Width � Width Tel. # Height Sq. Ft. xe;gLt Sq. Ft. Hgt/Ground _ Sq. Ft. i s�,��P `—� Corner Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks Type of Construction: EsGmated Cast: $ �cl ���_- Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ = S DATE: APPLICANT: Tei. 1! Peimit Fee Fire Surchazge State Surct�arge SAC Charge License Surcharge Driveway Escrow Erosion Control Patk Fee Sewer Main Charge TOTAL STIPULATIONS: � .l . .n S'1—`/T_ Fee Schedule on Reverse Side $ %i �� .001 of Permit Valuarion (1/lOd�%) $ , 7� $.50/51,000 Vatuation $ $850 per SAC Unit a ss.00 �s� ��a x�a�c� conn�o�� $ Alt. "A" or Alt. "B" Above $ 5450.00 Conseavation Plau Review S Fee Determined by Engineering $ Agreeme�t Necessary [] Not Necessary [ J �$ r , � � � � m � C m C O ? U � W Z O Na J W > � � Z w J U O W U o � � � a W F=Q � O _ � Q m p y O ¢� z � Z Z � Q � �¢ �a a �Z oa LLZ Z � O �H U_�___-_ _ J � Q � > � Z J � � F- � U W W = w z � cvn W a m �" v p � v�i � � j z � IL C � t�0 � .� a m � � � a N \��, � � LL � y� ;'4 \ 4 � �r � � � � � .� N � � r �� L � R i� U � � 3 � =° � � U m L ar y � I p Y t6 � '� `o l r � 3 L V 12 C � R 1� ia � � m U ` O O d «. C U a � O N � m � V � O V '� N .- a N L R R C C U N Y � Q � o c �a 3 o a � - N r W � n o o � � � � � o � m a� � ca D 7 C �j m C rn � m o � m � m C � � N W � c m � v tL- m 2 �' O J � I � 0 ��� � �gog ¢�oo Fa e� vi I N U � m � c m Y � Y V 3 3 m m C W 7 r � � � 3 Oii�'o = C � U � m a�1 a> d m ? 41 (L W d �1 C U N � a N ip Q .... p. q � N R ��Q C7 N O� c R Q N C7 � LtJ � 7 � Z � � m � � O Z F- � Q W � t n O U � H � � w � �;. Q� � m � I O = O � Z W N N ,_�j � � II N � � � C C C � � � R � o a � `) . I I rn c d d � 2 W Z `o � p R z� I � � ��� go O N v� �a � � �, � N � a I � c c O Z � C � O N � m Q � x � a m Z O H � ` � N 3 C O � � m U Q � Vi n N Q � O 2 � � � m L 0 00 Q� Q � W N � a 2 a� R Z � m E m m i �� ��� � O N C W � a � a m ¢ � O a c � � R � ' � � `o Ee O N U ^ N rn L � � � d m � w � J F O U � Z Z O � O ��n Z a� � O?� V n) � Q•is a ^ c °Eci� (j ; [ L L � � tp � Q.; =T1 Y � U a � r {n Zd a �O C� Z ug x � � 0 Z � d c � � m � > 0 a a a _O O � w lwL Z � F- U W a � Z W � z � Z O Q U � Q > Y a � � O U LL a W Q � � � Q � w og � a LL 2 � 0 L 3 a � � � '' 3 � O � � � d C �" _ O � � N � d C SO U o t° � C O A � U C N o N N C tn ° E r -c° Q O = a 3 �_ ��b�o � „ NOTE: lll through ll8 required when using a side vent furnace. �� �o �� .i8tl ��mm.�v .gu 2� CHIMNEY �ND STACK V�R�CATION The unctersigned bereby verifics t6at the existing clumney or stack: 1. 2. 3. 4. Has been c�refully ezamined Is free from rust or deterioration Has no foreign objects lodged within Is securely supported : � � � ., �� �� :� � � ,., � �_, ���:���� 6 Has tasal heating BTti's of gg, �7t� All other BTU's 34� d� TOTAL BTU's Il 5�0�0 7. Has a liner been ptovided Far water heater 8. Has combustion air been provided for water hester Remarks: � y : a • , � � ���,�s HEA1'ING CO: Signed By: Date: Yes (�No ( ) Yes (+�No ( ) Yes (v) No ( ) Yes (t�No ( ) Yes (t�o ( ) Yes ( ) No ( � Xes (t� No ( ) SED"uN'!CK HEATING 8 AIR CONDRIONING C0. 8910 Nlentworth Avenue South Minneapolis, MN 55420 �,, .Y �, ;. ` SEDGWICK HEATING & AIR CONDITIONING CO. HE^TiNG �pg Np �°6$� ° 8910 WENPNORTH AVENUE SOU7H • MINNEAPOLIS, MN 55420 •(612) 881-9000 TEST RECORD ADDRESS S&�� ��CC��P+•wra�r /�LL OCCUPANT 1�O/F �G d1 SOLD BY .Se� ��C l� MAKE CITV /-r • a OWNER _ INSTALLED BY Mooe� 3g3 (�p�GY2 ov/ SERIAL NO. �S �7 �O � I6 � INPUT rY.� G �O ,w �i THERMOSTAT �`� � S G VEM SIZE Y VALVE � y��E �`� TVPE OF LINER Y� G� f LIMIT . . �!'7ft�1' �.._ _ LINER SIZE S �� O LIMIT SETTING 20� FAN SETTWG ���"��� PILOT TYPE �/rc�d�C IGNITION MODEL i" �''f� � PILOT TIMING C Qn�'4"` � PRESSURE 3� S"w�C PEflCENT CO, gyo INPUT CPH � g PERCEN7 Oi 6 So STACK TEMP.7GGG PERCENT CO �� FORM 235 (FEV. 1 L59� FILTERS: SIZE 2 0 Y23 �` � NUMBER I WIRING Kti r� f �Oh TEST TAG J LIGHTING INST. ✓ DATE TESTED � � � � � 7 COMPANY TESTMG SGC�3 w.�L r� NAME OF TESTEH I�'4c G MA�` �� FOMI DISlAIBUIpN: WI1RE COPV - JOB FlLE YELLOW CAPY � Cltt � vg m �w - _ Z` � N � � � 3 c7 C 7 C v k' O y y �.���:�LL�:: > � � � � C W � d H � Q W a � Z � Q � ❑ Z Q � Z m i J a R O LL Z O F a U J a a a _ � Z 0 O C O b LL � O ;'^' � W Q N X � LL LL .. 0 'r,::!;j��. Y Q _. .. - - - _.� > O Z O H w a W � Z z Uj ¢'> oNi � �y N LL j Z LL �C � � O � � � � � W "O N U � ii u�i W c � C N � �- m � o � o N � LL m v `o `o 0 0 LL LL � e�� � � yl� � � .� � � W Q O ¢ m Q a L 'O � � � N U 3 � . � _ U y U jp d � 0 � � � `p " .t. V \ � r'� c 3 m � N V U � m � � d ° � �a ° o w c C U m O O � L A �m � v o U C a �a � 10 a a c c � W ' O q Y L Y � � ~ '" 3 0 '`- Q.: E m rn y —� c �aa°D m N ✓ � N L � m C V ' C Y � i' d '01 �N \ H W q N � N D � d D m • a ` '�- 2 m d � � N N � 'O 3 L a c � F- W m N 0 � Q 'O W N � rn c v .� m � � � U � � Z J W O � � Z �C � F � � O ^ M � V � .Ni �[] a � Z � t� � � u � � -7� � co �y � � m �r � C z � ¢ a � U U >- � � m � Z O m i. E � \yz �y �UU w a O I( I I I I I I I I..I I' . 0 0 0 0 0 0 0 o p o 0 0 w o 0 0 0 0 0 0� o 0 0 0 � !� O N I� I� I� f� O ri O O O Q en en rn tn tn w w fy en ia in di __ ¢ . . .__.. .---_.. .- ----- ---.__.- --- z IIIIII1IhIIz i/1 w ¢ Q w ¢ � X � � Z m � � J a N } a d m y �Q X Y � V � Q LL m 'Zi. � m m °;' v rn 4 W� m Z`y � 10 C p� I 1 >y N y�j �� C b C J'� � N W• • �, C � m�UI U y N N � Ul X OI N� m N¢ �„_ �?� O {L O � � U� a N m` a`I ¢� Y 'o o • ro m m zommc�¢in333c�c�m I 0 0 N � I N Z O_ ¢ ¢ H Q � � U Z m Q '_ � �- p� a ¢ = a `o o W m O ¢ � Q � Q LL m � `o °' Q d LL > � W � � � O w O � � ¢ a ' � � c `. i m � � � � c I LL _ m m O c 1 t 01 � ¢° m V w 0 a a Q o �I N H � w w N LL � W � t p o r � � m b � N W 2 U z 0 W W W N � � 7 � z � a � � w J m H � Z ¢ a V 0 N z 0 H W � U � � s w a w � > _ ¢ a w m J Q z m Q ¢ Z O F � � O ♦ SEP-28-2005 01:14 PM STFlNDRRD WHTER CONTROL 763 537 V�a i viu.�i..n� �,... �..�� � ..�..�� ..... �,y�n� �) SINOLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: �egal CascrlptieF: _ O�'+i in( NaifiB tS Ajiqf� Contractor: , `?� L1VINa AIiEA: DARACiE AREA: � 882 aaor cb?�3�� � (78�) 671 Ta�.#�/a-fs/ -959,P MN LICENSE *, ��� �`�7e�. # 7/. �-_��� 4/,PS�9 Attach to this application, a Certiilcate ot Survey of the lot, with the proposed constructlon drawn on It to scale. D�SCa1PTIQN aF IMRROVEMENT Lengih Wldth Height Sq. Ft. Lenfltfi Wldlh Helght Sq. Ft, DECK AREA: Length OTHER: yWdth Hgt/Ground Sq. Ft. Constructlon Type: ���'��� n�'�a .�,/S� Estimated Cost: 5,��� �� �� Drivo�.vay Curb Cut VVldtn Needed: _Fi,�B Ft = Ft x S�}�'� = 5 �--Y�"_� ��f_`?� � �/1 f`/ ��i� .L ,-� / .t.(�/,r` . Tei.�'%1a3-�.�%�/��/9 uaTE: y v` (i APPLt�ANT: Call (T83) 872-3904 for Permk Feea If malllnq in applitatlon. Fax to 763�671-1187 it usinp cre4it card and we wlll c�11 yuu ror card numuer. CITY USE oNLY - Permit Fee �ire 5urcharge State Surcharge 5AC Charge Licensa Surcharge Curb Cut Esctow Erasion Control Pafk Fee Sewer Main Charge IOTHL ��'%R�� $ ��.�o � �� r � $�� $ � $ Fee Schedule on Reverse Side .OG1 of Permit Valuation, (1110th°�) $.50/�1,000 Vaivation $1275 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt ��A�� or Alt. ��B" ADove �45Q.p0 Conservation Plan Review Fee Dstermined by Engineering Agreement Necessary [ ] Not Necessary [ ) � ��.0� ��r,�rr.r� ��� LA�-�Q� I ��� rsu�imng Inspectxons 763-572-3G04 r�ns,+rPUCnN'ris: �v�tv�r From: unknown Pa e:1YL Date:11/19/20072:58:01 PM �No,��7-(.�-3ca� SI�.I..LDING I �— RESIDENTTAL APPLICA.TION � � : 11 a�•1 , . :� -��.,,�-�!� SUBMPII' A COPY OF sre[E YOUR S?A'1'E LICFNSE �� Wi7'HAPPi.TC.AT7f.ttd � � ^i • � M *� DF4�mv WORZCBEIIdGDONE: �P•f-O�' + +(eYnn� sQvnxss .Z� .`'� 3 i c� I , �+, 1'P P. '�'�: 1' V�' • I � M l tl � l- �.�•.:a. ia :n� �. . .. ■ • ..� • � I,.r,_•r..- i .YI' 1't �" II t' ■ . •i . � � �"' 11��' . q. �i. �1�.� � �.y 1 K �: : i ' �' ..— r.•.�,� Pltm TiCrklv F� SwcLarge Surcha�e L�eme Smehatge SAC Ch�ga Cu[b Cut Esca�w Erosiam Conhol l�ic Fee SeweC Mara Cha�e '['I� 19-a97 V.B.0 P'6E ry.� _ . r � i r � i � �� � �g � g�eP��+' RAMOf]Hf �7�.�,���T• l. F.7diti06FI00fPI1W. x Paovo,.asoornLe 3. LhxatsCwmnla�eoamEemaG F�RI��N CONSiRUCIIODI II'If'd.11D1NC DECKS� w.va�n ,Q Po �a s �w+rr I. SiOePlmSurneY�owi�6��8� asdP�P�� 2. 7wo s�1s of oo�tracaao pLos 3. FaagyCalmleefon5 65% of�g Pawit Fce � .00L tiaaea'�e mtal job velwaam �" .0005 x Pamit V,�tion Nfmimam SSO 55.00 (Sabe Liomsed Resde�al Co�actoca} St675 per SAC Uffi (Plaus to MWCC Eor detamme�on} � $+Bft= itxS21=S � 5450 Consava6m Pl� Review � Pae Aete�mined by Eaqmem'io6 � A�{eemeot �erY ( ) Non N�s[y� ( ) 7'PDS i3 nx nPPI.[CnitON POR n PERMI'rarOr vN.ID vN7u, mOCESSED T herab9 �PP�S � 8��S P�t and I sc��owledge t6me the imformatiam above is oomplete emd aalua� th� the work will bo m amSoimm�w wtth aw md'm�cm and codw of t� City aFFridlcy and,.;rh 9�e Miomesofa f.onmucdoa Co�s; sh� i �eudars�and this is na a parmit but On1Y W appli�aRan for a pe�it and waait is �t W sta�t wikhout a permit, fhat the work will ba m axordence with the approved plan in ehe mse of aU wotk which yreq,ufrefs miew ead appraval of plsna. f�P.l �'���-�� , Ll�. 3[GNATUREOFAPPLiC.ANI' GL?�'�-' PRtNTNAM6C�1V1 �.. riA"� � � I�l O�i