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P - 47294Building Inspections 763-572-3604 SITE ADDRESS I { 7�1 `f THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMTT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERMIT TYPE TYPE OF WORK: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY � VlIiTR F_M41i. ADTIRACC. �OXJ � � 1 1� �i I l` >N• ; r27 L ADDRESS: � " •� CITY, vuniaF• (�J� • Z �O • � Q"S3Z STATE LICENSE # o� I%3 � EXP DATE �I�1�0 % ADDRESS: S S5S �L�"L' CITY � Pxor� 95z, • 93.� � 4l0�9 Fax 95z • 935• 9s�y � SINGLE FAMILY/NEW CONSTRUCTION SIZE O TWO FAMILYMEW CONSTRUCTION ___ STORIES i ❑ BASEMENT FINISH ❑ ROOF ❑ DECK ❑ SIDING DESCRIBE WORK BEING SIZE OF IMPROVEMENT � LENGTH Permit No.: Received By:�'r�l� Date �'°�: �� � �` �v� � � � �U.Sev • c v m ❑ DRAIN TILE O OTHER POOL 1G ) Wl�01� � � c�llS �_ WIDTH HEIGHT � A� ���53�3 Ft. NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GqgAGES ❑ ATTACHED GARAGE 2. Prop s dFfloor plan PROPOSED SIZE: ❑ DETACI-iED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, O Vinyi QSaift AI?DIT:QNS. & PORCHES SUBNIIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing ffie existing swctures ❑ Other ❑ Fascia and proposed project WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS es �No LOCA i0 OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS-DESCRIBE SiZE OF ) I%1 Y 0 6 Yh OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED O NUMBER OF WINDOWS � ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: ([JSING THE 997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ ���� OCCUPANCY TYPE — Permit Fee Plan Review Fire Surchazge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ ///, Z$' See Back Page for Fee Schedule $ 65% of Building Permit Fee $ L�,�jZ .001 times the total job valuation $ z. cf (9 .0005 x Permit Valuation Minimum $.50 $ � -- $5.00 (State Licensed Residential Contractors) $ $1550 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$21=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ . Q Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclaiowledge that 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 application for permit and work is not to start without a permit; that the work will be in accordan e with the approved plan in the case of all work whi requir'e r iew n a roval of plans. � �( SIGNATURE OF APPLICANT PRINT NAME W� ( U DATE - -