AF - 46663_
�,- � � °`��,
BUILDING PERMIT
Village of Fridley, Minn. No 2 c y y
Date .ar!iQ!t!�h A!+� . .� �y�. X . . . . . . . . . . . . . . .
Owner . �.1�. . . . � Builder . . . . G� . .M'�Q . . . . . . . . . . . . . . . . . . . . .
. J,. �.. ............ /�/� Address ....................
Address ..A (JG.S1. • •.. .Y..`;!`.!`"!'•..`.-'..l..A./.LR"�V
LOGAT1ION OF BUILDI G
No. . . . . 1�.4e .. .. . Street . . ... .��'�,�.�,�/1ly�2l�.a. . ` . Part of L t ... . . ... . . .... . . . .. . .
Lot .....�........ Block ......�..�ion or Sub-Division . .. . ....... ............
Corner Lot . . . .. .. .. Inside Lot . .. . . . . .. . . . Setback . �.7. . . ... . Sideyard . . . %�.%.rrii,.�a.� . . .. . .. .
DESCRIPTION OF BUILDING
o b Use s
. . . . . . . . . . . Front � � . . Depth . .i� . . . '-Ieight � Sq. Ft. �Q. Cu. Ft. . . . . . . . .
.................... Front ..,..... DePth ........ Height ......... Sq. Ft. ........ Cu. Ft. ........
Type of Construction .��,.�/!�• E� Cast .1.�9F �?.�.�........... To be Completed ...................
t/�� :
In consideratioh of the issuance to me of a permit to mnstruct the building described above, I agree to do
the proposed work in accordance with the description above set forth ,and in compliance ,v�tlp all provisions of
ordinances of the vIllage of Fridley. /J �� /f � / p
���G�1'�!�/-�
nstderation of the payment of a fee of $./��, ,.. ., permit is hereby granted t' � .. .. .. .... .... ...
. to mnstruct the building or addition as described above. is permit is granted upon
t express condition that the person to whom it is granted a is agents, employees and worlmien, in all work
ne in, around and upon said building, or any part ther , shall onform all res ects to the ordinances of
Fridley, Minnesota regarding location, construction, alt ation, mai enanc r p mo g of buildings with-
in the village limits and this permit may be revoked a any time on vi at' y of he provisions of said
ordinances. / � � , .
..`�,.,,�„!,�l�/,�'�Building Inspector
NOTICE:
This permit does not cover the construction, installation or alteration�Niring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these items.
�
City of Fridley, Minn.
BUILDING PERMIT lv� 7311
• Da�: _.��� �-�-y--�� ___ _
,
Ovmer: '
_...:....�....-----..___...__.—......—_..—�—_� Bwlder . �.._ ..... ..._.. . _._ .._.._...
Addresa..__......._...._._...._..._..__.._.._._.....�..._.__....__...__._.....___ Addi'ess _.__._._....._. .—........._........_._..._......_.........-----.._.
•
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/,{ � pU1LDIN
No. !___pSs1..._ Street .... ... ..-- - .- �_ , _. s.� oP Lot ....._...—..------._.._...----
Lot .__....._�_.._...__ Block ._......._..._...._...—._...._._. Addition or Sub-Divisimt ._._......_...-----'-----�..._.—..__
. '� < '/
Corner Lot _.__....__.._._.._ Inaide Lot ..—_.`�..._..�_..... Setback ...�-J..._._........_ Sideyard .......__.5./_.._..----..._�_.._..---...--
Sewer ElevaUon
//l�� /�
Foundation Elevatian
DESCRIPTION OF BUILDING
Front _.�.''!.._ DePth _�-_:� HeiBht ..._ ��_ 34. Ft .�x..� GS�. Ft ����/
__._._..._.._... .�....._......_._. .. Depth _...---... Height _..._... Sq. Ft. .---...__..._ Cu. Ft
. _�. _...—_
1j�pe of Constrtt ._...._. �.. Est. C ../ .� _�._...__l To be Completed ....._.._......._._...
In conaideration of the issuance to me of a permit to const
the proposed work in acoordance with the descriptioa above set
ordinances of the city of Frldley, ,
I agree to do
praviffiona of
In consfderation of the payment of a fee oY _ '. . permit is he%by granted to__�—
� ---�
.,._._...___�..__..._. __.___. to rnnstruct the bu3lding or addition as described above. This permit is gisnted upon
the express condition ihat the person to whocn it is granted and his agents, employees and worlanen, in all work
done in, azound and upoa eaid building, or any part thereof, shall mnform in all reapecta to the ordinances of
FYidley, Minnesota regaid'vig locatioq construction, alteration, maintenance, repair and moving of buildinga
��� dty limits and this permit may be revoked at �h'me upon vi�ation of auy of the proc�isions of said
/ 1
Building Inspector
NOTICE:
Thh p�mJ1 dws �roe cmvr flw cenNrusNoe. InMa�tlbn for rririny, PIue660. yu huNny, crwu er waM. N wn ro aw
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Date
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Address
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BUII.DING PERMIT
i
Village of Fridley, Mi.nn. No 2 o y y
. . . . . . . . . . .� .�. l.��� . . . . . . . . . . . . . .
. � ��.. . . �,,,4.ry!-�� .. . . . . . . . . . . . Builder . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..� ��.....7'-` .. ...............`.e��L.t��V Address .........................................
LOCAT ON OF BUI�G
/!'� �
No. . . . . /O��!. . . . . Street . . . . . . . lKPN�.e. . Part of t . . . . . . . . . . . . . . . . .
Lot .....�........ Block .... .r�....... Add"on or Sub-Division . . ....... ............
r r`
Corner Lot . . . . . . . . . . . . Inside Lot ... . . . . . . . . . Setback . �.7 . . . . . . . Sideyard . . . %�%.�..v,..� . . . . . . . .
DESCRIPTION OF BUILDING
o Us
r
. . .. . . . Front �.. . . . Depth ..!/.. . Tieight . . Sq. Ft. ��. Cu. Ft. . .. .. .. .
. . . .. .... .. .. . . .. . F'ront . .. .. .. . Depth . .. .. . . . Height . .. .. .. .. Sq. Ft. . .. . . . . . Giz. Ft. . . . . . . . .
Type of Construction . /� R,. � �. � Cost . l �F �� V . . . . . . . . . . To be Completed . . . . . . . . . . . . . . . . . . .
In cor�sideration 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 ,�nd in compliance cyit� all provisions of
ot�clinanc� of the villa¢e of Fridley. n// /� // �
�
. . .`�
n t�sideration of the payment of a fee of $./�. . permit is hereby granted t .. .... .... .... .. .. .
eyt.sn.�r,.. ..., to construct the building or ad dition as described above. permit is granted upon
� express �ndition that the person to whom it is gran ted is agents, employees anc� worlunen, in all work
e in, around and upon said building, or any part ther , shall nform ' all to the ordinances of
Fridley, Minnesota regarding location, conslruction, alt ation, ma' enanc r mo g of buildings with-
in the village limits and this permit may be revoked a any time n vi of e provisions of said
ordinances. � ilw�
..�!.�r�Gi�i����/Buil�ling Inspector
NOTICE:
This pe�mit does not cover the construCtion, instailation or alteration iring, plumbing, gas heating,
sewer or water. Be suro to see the Building Inspector for separate permits f�r these items.
�
-._
City of Fridley, Minn.
BUILDING PERMIT N� 7 311�
' Date: _ ``.���'�
�l""�
Owner: _. ._._....__..._......__ Builder .. _ _..._ ._.._
Address_.__._..�..._.._..._..._..______._.�.__..._._... _.__._.. Address _.._.._.__._.._.._..._._. .__._._......._..__......__..._.._._._..._....--
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No. ..._.. . Street _. ......._ . o! Lot _.
Lot _._.. _..._.__ Block ._.._._...__._.._..._..__.._._._ Addition or Sub-Divisian .__.._.._._..
Corner Lot � .r Inside Lot .....� `� .._...._.._ Setback �� � ._ Sideyard ._._� /
Sewer Elevatia� �— ___.____._._..____.__...._..__.._.._ Foundation IIevation
DESCRIPTION OF BUILDING
T as:
_ �ant � Depth _..� !� Height . `Q Sq. F'� .���! Cu. Ft �7�.��E
v_..._._....... _.___.__ � ____._.._.. Depth _...___.. Height ._._ Sq. Ft. _..__._._....._ Cu. F't. _.._.
Type of Conatru . ��� To be Completed .._:_.._.._..�_.:._.._._..__.—
. ._. _.� �� .. Es� �.�..�..._...__
i
In caavsideration of the issuance to me of a permit to caa�struct�h�b wlding des above, I agree to do
the propoaed work in accordance with the description abave seti���fly�nd i� comp ' wit,p all pravisions of
ordinances of the dty of Fridley. � f� / ., /
In caosideration of the payment of a fee oP �—...._.., permit is he by granted to._.—
to oonstruct the building or addition as described above. This permit is �anted upon
the expreas ca►dition that the person to whom it is granted and his agents, ernployees and workmen, in all work
done in, around and upon said building, or ar�y part thereof, shall conform in all respects to the ordinances of
Frldley, Minnesota regarding locatia�n, construction, alteration, maintenance, repair and moving of buildinga
withiu the dty limits and tbis permit may be revoked a t any tinae upon vi taon of any of the provisions of said
or3inano�. �� /1 �
Building Inspector
aoTicE:
Yhb p�rmi! doN aof eowr tM �oalrvdioy iahqNion for wirMf. P�Y. N� �Y, aw�r or wMrr. d� wn to sN
fM suiWia� la�elor for s�p�raN p�its for fb� i1�ms.
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sua�ecr PER _
City of Fridley 1213
' , AT THE TOP OF THE TWINS g � I L D I N G P E R M I T O
r
� �` COMMUNITY DEVELOPMENT DIV.
r � ~ � PROTECTIVE INSPECTION SEC. ��,��
� �
' � �'��1 � CITY HALL FRIDIE� SSI32 NUMBEH REV OATE PAGE Of APPROVED BY
�""� � ,'' 612-571-3450 9t0-F15 2/21/92 � �
JOB ADDRESS 125 Hartman Circle NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. '] 2 Sandhurst Addition SHEET
2 PROPERTYOWNER MAILADDRESS 21P PHONE
Raymond Anderson 125 Hartman Circle NE 571-7390
3 CONTRACTOR MAIL ADORESS Z�P PHONE IICENSE NO.
American Remodeling 3700 Annapolis Lane P1 outh.55447 553-0020 2406
4 ARCNITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADORESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reside Dwelling (Vinyl)
9 CHANGE QF USE FROM TO
STIPULATIONS
TYPE QF CONST. OCCUPANCY GfiOUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING.
VENTI�ATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NUIL AND VOID IF WORK OR CONSTRUCTION ZONING SO. fT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED FOF A PERI00 OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCEO. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALIS GARAGES
ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WIIL 8E COMPLIED $11 600 $5�HO
WITH WHETNER SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT �
OOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERMITFEE SACCHARGE
PqOVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING co►v- $135.0� Fire SC $11. FO
STRUCTION OR THE PERFORMANCE Of CONSTRUCT�ON.
PLAN CHECK fEE TOTAL F
$1 .4Q
SIGNATUi7E OF CONiRACTOR OR AUTMOpIZED AGENT IDATEI WHEN ROPE Y A THI YOUR PERM IT
SiGNAtUREO:OWNER�1fOWNERBUILDERI IOATEI BLOG �NSP iFTE
� ��
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constnxctian Adclress:
Leqal D�iPti�' _
.
owr�er rrame & .
Contractor: �
�: � �aa
R-1 AND R-2
R,; t dir�g Permit Application
/o�� i'S�C1� f/�x a��G ' �� Q�� i��
Effective 1/1/91
�,�. �. �`"�,i , ��o
Zte.l. ���OQ.�U
�i�C i :�����`7
Attach to thi.s application, a Qez�tificate of S1�vey of th�e
lat, with the pro�osed ooa�tZVCtiori drawn on it to scale.
DF�C�tIPrICH�1 � II+��'1VH�III�TP
LIVII� ARF��: Le�z Width Heic�t Sq. Ft.
c�R�GE �: Ie,rz�th Width Heic�t Sq. Ft.
DECR ARE:�i: Lerr3th Width Iigt/�auxi Sq. Ft.
0li�R:
Corner Lat [] IrLSic1e [] Ft ; Yd etb Side Yard Setbacks
Z�pe of Qonstnutiocz: /�� �� Esti.mated Q�st: $`/ C��
Approx. Uo��letioa� Date:
PYr,posed DriveGray Width If New Is Desired: Ft. $ S
�
n�: �,/ 9,�a � 6 �see sa � o a C'
U�E '
Permit Fee $���`� �ee Sc�e�ule an Reveise Side
Fire S�c3�arge S�-���. ooi x Pexmit vatuatic� (i/ioth ��
state sizrharge S � U S.so/Sl,000 valuation
SAC Q�arge $ $650 per SAC Unit
Driveway �scrow $ Alt. "A�� or Alt. "B" Above
Park Fee $ Fee Detennir�eci by Engineexi.�
Sewer Main Ct�ax�e $ Agraeaent NeoessaYY �[] Nat Nec�ssazY � l
�, $ /�'a. �o
G�' ���
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ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
s�i-36U4 r�Ax:
: 125 HARTMAN CIR NE
: 153024120044
: SANDHURST ADD
: LOT 7 BLOCK 2
: HEATING
: RESIDENTIAL
: ADDITION/ALTERATION
571-11if7
PERMIT NO.: 200400062
DATE ISSUED: Ol/16/2004
VALUATION .
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER.
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A
MAKE CORRECTIONS TO VENTING ON GARAGE UNIT HEATER TO BRING IT INTO CODE COMPLIANCE AND SAFE
OPERATING CONDITION.
# A/C UNITS � 0 VALUE OF APPL OR WORK 409
#FURNACES
# GAS RANGES
APPLICANT
NORTHERN HEATING & AIR CONDITIONING
9431 ALPINE DR NW
RAMSEY, MN 55303-
(763)323-7597
OWNER
VOS, JOEL
125 HARTMAN CIR NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worb
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp Date
0 # GAS DRYERS
0 ENTER VALUATION
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS PIPING FEE
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONING FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 9436
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
0
409
25.00
0.00
0.00
0.00
0.00
0.00
0.00
0.50
25.50
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ADDRESS
PIN
LEGAL DESC
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
s�i-36u4 r��:
: 125 HARTMAN CIR NE
: 153024120044
: SANDHURST ADD
: LOT 7 BLOCK 2
571-1Ztf7
PERMIT NO.: 2004-01816 L��,' !� I
��
DATE ISSUED: 10/OS/2004
PERMIT TYPE : ELECTRICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION .
NOTE: ELECTRICAL PERNIIT BECOMES VOID 12 MONTHS AFTER PERNIIT ISSUE DATE. INSTALL A SAVERS
SWITCH.
# INSPECTIONS 1
APPLICANT
HUNT ELECTRIC CORPORATION
2300 TERRITORIAL RD
ST PAUL, MN 55114-
OWNER
KAY MEAD
125 HARTMAN CIR NE
FRIDLEY, MN 55432
ELEC PERNIIT FEE - MIN (RESn
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 118132
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant _ Date
Bldg Insp
Date
�nrHnt� i r, r�icmi i � x Gllu 11c�1� r VK W VKK V l tir;K l HAN llr;5C;K1�3�ll ABUVE.
20.00
0.50
20.50
r ■
City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287
6431 University Ave NE
Fridley MN 55432
Mechanical Permit # °�Dd�- ����
Residential Application
City of Fridley
See Back Side For Required Information
Date -.2 -OS SiteAddress: 1�5 NarfrnaK C�rc�c �/�
The applicant is: (cirlce one) � Contractor c
Property Owner: Ka �, �f e a d-(.bs �� d e f Vo s
Address: IZ$ fi(pcifcn-ran c� r c le .�/�
City: �, o �£ Y State: ,�'t � zp: ss y3z - v�iz
Phone: 63 � zo5 -�//d y Cell: Fax:
Contractor Information
Company Name:
Contact Person:
Address:
City: State: Zip:
Phone: Cell: Fax:
Email: MN Bond# & Exp Date
Type of Work (circle one): New Re lacement AlteratioNRemode
Detailed Descriptionofwork: ��� (la r�en a� �� �.ne For cw�rqo ra.��
Equipment Installed: MFG: Model: Size/BTU:
MFG: Model: Size/BTU:
MFG: Model: Size/BTU:
Please check all that apply: _Fireplace (gas) $15.00 _New Gas Grill $10.00
A/C $25.00 _Fireplace (wood) $35.00 _Gas Unit HTR $10.00
Airto Air exchanger $15.00 Fumace $35.00 _Pool Heater $35.00
Boiler $35.00 _Gas Dryer $10.00 _Ventilator $15.00
Chimney Liner $10.00 Gas Piping $10.00
Duct Work $10.00 Gas Range/Oven $10.00
r�!�G
Permit Fee $ �J (Total from above-Minimum fee $35.00)
Surcharge � 0.50
Total Due $ � Make check ayable to C' of Fridley
rn�s is an app��cation tor a permn- not vaua untn processea
I hereby apply for a mechanical permit and I acknowledge that the information above is complete and
accurate; that the work will be in conformance with �e 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 application
for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in case of all work which requires review and approval of plans.
Signature of Applicant: � Date: � � ����
Approval Inspector Signature: Date:
Please Note: Separate permits are required for Building, Plumbing, and Electrical work
Revised 6/14/2005
Building
Inspections
763-572-3604
--7-oS
SiTE ADDRESS �
THIS APPUCAIJT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE L10Et�1SE
WITH APPLICATION
PROPERTY TYPE
BUILDING
RESIDENTIA,L A►PPLICATION
CITY OF FRIDLEY
Pcrmit No.:�
Received By: �
Date Rec'd: / 1'�7 �1��
YOUR E-MAIL ADDRESS /�a �fi'� ��Y1G10 C� �'►�1 h,(Y� �4�'yJ
�� /v�
OWNER OCOMRACTOR
PHONE•��o 3 �Z.D.S — �/ /D �
NAME:
STATE UCENSE N
c�nr
EXP DATE
���
ADDRESS: C1TY STA7'6 ZIP
PHONE FAX
SDJGLE FAMILY SIZE
O TWO FAMII.YMGW CONSTRUCi70N STORIES
PERMIT TYPE O ADD1770N
O BASEMENT FMISH
O DECK
TYPE OF WORK:
DESCRIBE WORK BEING DONE: S�1 � r-� I i h.ai
S1ZE OF
OFSQUARES_��
CARACES
PROPOSED SIZE:
PROPOSED HEIGHT:
S[
O Vinyl
O Aluminum
O O�her
WINDOWS
M EXISTING OPENMGS OYa ONo
OR FOR NEW OPEriINGS-DESCRIBE SIZE OF
OPENING CHANGES Qc
O GARAGEISNED O WMDOWS
�'ROOF O DRAM T1LE
� SIDMG O OTHER
O SWIMMMO POOL
O REMODELMG
LENGTH WIDTH HEIGHT
�iOUSE dc GARAGE
�ATTACHED GARAGE
O DETACHED GARAGE
OSoRt
O Trim
❑ Fuci�
LACATION OF WMDOWS
NUMBER OF
[3ASL•MENT REMODELMG SI�BMIT:
I. Existing Floor Pl�a
2. Proposed tloor plan
3. Lisc of slructural manbers a be used
F�
FOR NEW CONS7RUC770N MCLUDING DECKS.
ADDITIONS. dc PORCHFS SUBMff:
l. Site PImlSurvey slawing the existing structiacs
and P►oPo� ProJat
2. Two sets of oonstruction plms
3. Epergy Calculations
ALL FEES ARE BASED ON VALUATION, tNCLUDINC THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION S � a° OCCUPANCY TYI'E
Permit Fee
Plan Review
Surcharge
Fire Swc6azge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
Total Due � �
s 7.a5
� —U—
a .�. / �
� /, 60
S
S
S
S
$
$ _i
�
See Back Page for Fee Schedule
65% of Building Permit Fee
(.0005) times the total job valuation — Minimum 5.50
.001 x Permit Valuation (1/10%)
SS.00 (State Licensed Residential Contractors)
S 1450 per SAC Unit (Plans to MWCC for dctennination)
f�+6ft= ftxS20=S
5450 Conservation Plan Rcview
Fee Dctcrmined by Engineering
Agreement necessary ( ) Noa Necessary ( )
Make cl�ccks payable to: Citv of Fridlev Attach
THIS 1S AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and 1 acknowlcdge that thc information above is compicte and accurate; that tl�e work wil) be in
conformance with the ordinances and codes of the City of Fridley and with tl�e Minnesota Construction Codes; that 1 understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work which rc uves revicw and pproval of plans. �
SIGNATURE OF APPLICANT % -- — PIi1NT NAMG --71 a �� " `G�G� DATE �Z _ , Q � .
--� — - � �