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P - 37474���% . `� _��.�..�ki�� Bu�iding BUILDING permit 1vo.:_ Inspections RESIDENTIAL APPLICATION Received sy: ' '763-572-3604 CITY OF FRIDLEY Date Rec'd: C�—1 ��� 763-502-4977 FAX EFFECTIVE 7-1-2010 DATE I I'" "' I� YOUR E-MAIL ADDRESS m� S�V +'\ i' °�`''� ��m C�c� ^� s��ann�ss `�a o-c �,��.nn C,�� N� Fr;c�.i�. !+1 s'S�l THIS APPLICAI3T IS: �OWNER �CONTRACTOR � PROPERTY OWNER/ NA�: on� �� �,, �� TENANT ADDRESS: ��' �"� ��r^ ar`� � . � y � CITY r: � � C' `4 STATE � 'LIp SSN 3� PHONE: �'� � � � 3i' - a3 �. CONTRACTOR N,,�: SUSMTT A COPY OF YOUR STATE LICENSE STATE LICENSE # EXP DATE AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE pHONE FAX PROPERTY TYYE SINGLE FAMILY/NEW CONSTRUCTION SIlE �� �� �'' I.S� ° r � "" .�i� ❑ TWO FAMILY/NEW CONSTRUCTION STORTES�_ PERMIT TYPE ��DITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMINT FIIJISH [7 ROOF ❑ DRAIN TILE ,�DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME COIISTRUCTION DITIOI3 ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: J t � n cr. i. C� A�'� � �i v.C.I�� ;r,� y� nJ.S�Q S1ZE dF IMPROVEMENI' 1��C. �� ZIo.� LENGTH 3 WIDTH � 7 �i��rr `� `�, �� s FT �-�'� ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor pian PROPOSED SIZE: ❑ DETACHED GARAGE ,�r���� 3. List of siructural members to be used PROPOSED HEIGHT: V / SIDING !p �' i�l �� f,iJ /i,� FOR NEW CONSTRUCTION INCLUDING DECK5, � Vinyl ❑Soffit �� 1Tj �k ADDITfONS. & PORCHES SCJBMIT: ❑ Aluminum ❑ T� 1• Site PIan/Survey showing the existing structures ❑ Other ❑ Fascia and pmposed project. 2. Two seu of consuuction plans WINDOWS 3. Energy Calculations IN EXISTING OPEATINGS OYes ONo LOCATION OF WINDOWS FOR WINDOWS — PROVIDE (J-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUF'ACT[JRE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL r'L�'L�'� AKr; BASL+'ll UN VALUA"1'IUN, llV(;LUD1N(T 1"tix: CUST UF LABOR AND MATERIALS: JOB VALUATION $ a. qr�, �SING T3HF �9�7 U.B.0 FEE SCHEDULE) �1 L(� OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surchazge License Surcharge SAC Chazge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ $ $ $ $ See Baek Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $5.00 $5.00 (State Licensed Residential Contractors) $2100 per SAC Unit (Plans to MWCC for determination) ft+6$= ftx$24=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks navabie to: Citv of Fridlev Attac THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is compiete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridtey and with the Minnesota Canslruction Codes; that I understand this is not a permit but only an appiication for a permit and work is not to start without a permit on site; that the work will be in accordance with the appmved plan in the case of 1 wo whic equires review and approval of plans. 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