AF - 47021r T fi '.
sue�ecr ' PER .
City of Fridley �� 16 6 6 7
AT THE TOP OF THE TWINS B U I L D I N� P E R M I T
r
; � RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV. �� 7D
' ��: ---'�-�
r � � PROTECTIVE INSPECTION SEC. / 6�
i � �
CO
� � /"'1 � CITY HALL� FRIDLEv SS43Z NUMBER REV. � DATE PAGE OF APPROVED B�
�'"'"�� ,�� 612-571-3450 910-F15
7/9/82 � �
JOB ADDRESS 6172 Heather Circle N.E.
1 LEGAL LOT NO. BLOCK TRACT Op ADDITION SEE ATTACHED
DESCR. 3. ]. Hea.�her Hills West SHEET
2 PRQPERTY OWNER MAII A�DRESS ZIP PHONE
Mrs. R�ose 7.btino
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Brickner Builders inc. 6249 Ben Mare Drive N.E., Fridley 574-9871
b ARCHITECT OR DESiGNER MAIL ADDRESS 21P PHONE IICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Resic'�ential
7 CLASS OF WORK
D NEW ❑ ADDITION O ALTERATION O REPAIR ❑ MOVE O REMOVE
X
8 �ESCRIBE WORK
Construct a Darellin ( rox.- 74' x 39' ) and a Gara e(Approx. 23' x 24' )
sEPERI�TE P R�AtT
9 CHANGE OF USE FROM �� `r{�. r����`.�� `�� ����
r� s fiilt !r
STIPU�RTIONS Provide a hard surface driveway. Provide sod in the front and side yards
Provide copy of the verifying survey to the City before capping.
SEWER LOCATI013: Approx. 8.3' Deep In Street. Served out of M.Ii. (Inv. 910.76)
10' West of Water Service.
TOP OF FOOTING: 914.25 Minimum
WATER LOCATION: 39' S. of M.H. 10' East of Sewer Service.
DRIVEWAY DEPRESSION: NjA it built prior to curbing. wA��l�V
PAZn S1000.00 Park Fee Bt��t� 1i�tin� call lec�! utiUtie�
{•� u� r a� �r �,Npt �u��� z; ;;: �EIEPNONE • ELECTRiC - GAS Etc.
,•ccuR,n�t or �u�r t�►t�o� �►u �EV�,�c�.::. REC,�UfR�D B�Y LA
tm: a►t� a rot +N'Qwano+� rwciayc oa,tr �
►�st� w� �r-rOWP t�R t� �
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T'fPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS AfiE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING.
VENTIIATING OR AIR CONbITIONING. WOOCI FrdIIl@
THIS PERMIT BECOMES NULL ANO VOIO IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHOiiIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R�1 Z%HO
ANV TIME AFTER WORK IS COMMENCEO. NO. DWLG. UNITS OFFSTFEET PARKING
l HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLfCATION �. STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $159, 500 $79. %S
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS ANY OTHER TE OR LOCAL LAW REGULATING CON-
STRU THE PEAFO A CE OF C_STRUCTION. �S93.00 $42r'J.00
PLAN CHECK FEE TOTAL FEE
�� �� $148. 25 $1, 246.00
SiGNn7uaEOFCON�Aa RORAUTHORIZEDAGEN7 IDATEI WHEN PROPERLY V LIDATED THIS IS YOUR PERMIT
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SiGNATURE OF OWNERUF OWNEF BUILOERI IDP I BIDG WSP TE
��c�'t� ��' e� � � `� -
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RONALD F. NIEYER
I.AND SIIRVEYOR
uNC au�ev�riNO suaorv���on on�an
Ta.=PHONL ���.a3es
��_�_--�' '� '�`.� �'^'Lt� '�`,
; . . . �.,�.>.�.;� � , �
�B�J Ji3fl[ ST, ST. PAUL. MINN. 'JEIO1
I hereby certify that this survey was prepared by me and that I am a duly
Registered Land Su�veyor under the laws of the State of Minnesota.
Reg. No. 905i Date: �f ��, �'�8 L
� ������ utilit�es
Beiae di�g��ELECTR�Ca� 6AS Etc•
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Lot 3, Block 1, HEATHTR BILIS WEST, �noka Caunty, Minneaota.
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1. Total exposee� �a3.�1� area ....,. ���0 s�. ft. x'� = G�� y(�
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' 2. Total roof/ceiiing area . . . .a � % sg�. f�. x - �� - / - �`�
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• Tot`i exposed •�a11 area above_ fioor_ _
_ , a. Total wal? �ia�do�r ar�3 _ . . a . . . . . . . . .. .. �_.:. .�� .:. _ . . . a � � � � � . -'
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_ b. Tctal . doo� a��a_ . _ : . . . . . . . . . . . . . . . . . '.�. .._ f ... . . . 5�,�- `i �
c. TotaZ siidi�g ��ass d�or �-�a. _.. . .��v.�;.. f.. .. .
� � _ � d. Tota� fire�iaee ��? 1 area. .-. . . . . . . ..... _ . . . . _.. . . .
, e . Tota l �wa ll �rami�g area { av�rage_- �0/) .: .. _ . . _ . . . , . � - � -
f . Tota� net ��a�� �sea above �? =o� . . _ . .:. . . . . . . . . . a � , �"t.
Total r� jflisi aze� . ` `v �
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$ . 1 � � _. _
� , - Tota� ex�ed �o�:nd�t? cn �r�a =
� h. Total foundation s�rindow area . . . . . . . . . . . . . . . ... . . . J � ` � � '
i. Total net �oundatioa-area above grade........... %lY�— �
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If item #3 on prev�.ous page is the same as, or less than i�em #1,
you have met the intent of SBC 6006(c)2.
, Total exposed roo.f/ceiling area = � �
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j. Tota�. skylight are . ..�i' �...i�....... �-�6
_ k. Total ��ca� cei � in framin ai�ea -:(ave�ag� �Cp)
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1. :To�a3 net. � nsu�ate�i roo�r'ce��ing< area. . e . . . . . �S ��
-�. Determine "iT" 4�ai�se �or eacra roo��cei;.gng segmerat.
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!' if �otal of r4 above is the same as, or less �ha:� ';-2, yo�: have met
` the intent u� SBC 6�OE (c; ?. _ -
: ; -_ _ �? �emate 'Bui? ���� �:�ve? oae De�iur_- _
_ : T�.- uti2ize ���e �cta�3� enve3o�e sys�� me�:oti� ��� :;�=ua� es ��? ishzd-
by t;�e s:im of �L�ms "? �nd ;°,'-4 •sha? Z not be g��a ��r �han �hc� sum �
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CITY OF FRIDLCY Effective Aug. 1, 19s1
APPLICRTI��I FO(� RCSIDE�ITIII� IiU1LpIilG PCiL'liITS
(Ne�•r, Alterations, Additions, or Repairs)
o�,����t:,�'��`S r� CF TuT1 �✓Q
ann�:ESS: %lJ'� .� �
TEL N0:
QUI LDER :�lp i c-,�1�/�',C � Ui G/' E�J //(/G
�o��ss: G�y� ���� ���F �,�
T�� ��o: S-,� y, � �-�1
Construction Location
• ST7tITT NO: C�� � Z STItEET: /��i'9 %/���' C/� � c- F
Lar: � sr,ocsc: / AnnzTioN : /�`<<>//�� �` / � c � �.� �- .� 7'
Corner Lot: Inside I,ot: /� SetbacY.: � Sideyards :�� w� U
Ap�licant attach to this forn two Certificates of S1.�rvey of lot and
prop�sed building location drawn on certificates to scale.
DESCRIPTIOi� OF COFJSTRUCTIOW
� r /
Front: Depth: Height: I Z�
Square Feet: Qibic Feet:
. � � �— Front: Depth: Height:
Squar.e FePt: �`� Wbic I�eet:
A,� . • ��` � .�
Zype of Cor,struction : �� ✓Vt � Estimated Cost: $
. i
Rb Be O�r.�pleted: �-/ " J 2�
Propcsed Drivea,iay kidth If New Openinq Is Desired:
Alt. A Alt. B
$ $
SE� I�VERSE SIDE OF SHEET
Riie undersigned hereby mal;es application for a pez�ait fcr the �1ork herein specified,
agreeing to do .all work S.n strict accordancc ��ith the City of rridle}� Ordinances znd
rulings of the Delklrtmc�nt of Builc3ings, �nd hereby declares that all the facts and
representations stated :n this applica -
/J �
D.'lTE: ' / � � �-- SIGNATUI�:
Stipulations:
p��- s�c'�.o�i�
p �— l �P� � a�
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s� c�a� �
P� �o�.
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sue�ecr M .
City of Fridley 19231 �
AT THE TOP OF THE TWINS 6 U I L D� N G � E R M 1 T
�
; � ECEIPT N
� 1 y�����_ COMMUNITY DEVELOPMENT OIV.
r � � PROTECTiVE INSPECTION SEC. �6 S��
� � �
, � /"'1 � CITY HALL FRIDLE� 55432 NUMBER AEV- DATE PAGE OF APPROVED BY
�'""�' �'� 612-571-3450 910-F15 10/7/87 / /
JOB ADDRESS �j].'72 Heather Circle �. E.
1 LEGAL LOT tJO. BIOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 3 1 Heather H111.S GT@S� SHEET
2 PROPERTY OWNER MAII ADORESS 21P PHONE
Imse Totino 6172 Heather Circle N.E.
3 CONTFiACTOR MAtL ADDRESS ZtP PIiONE LICENSE NO.
Milton L. Johnson Co. 2513 Central Avenue N.E. , Mpls. 55418 781-9548
d AqCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE N0.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION �7 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Ins tall aluminum soff it/ �as.cia/ Trim
9 CHANGE qF USE f ROM TO
STIPULATIONS
SEPARATE PERMITS ARE HEQUIREU FOR ELECiF11CAlr�LUMB)NG, HEATMt3, TYPE" CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK .OR CONSTHUCTION 20NIFF6 SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCEO WITH�N 6U DAYS, OR lF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A pER10D OF 120 DAYS AT
ANSY TIME AFTER WORK IS COMMENCE0. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION �- STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yqLUATION SURTAX
ANO,ORDINANCES GOVEiiNING THIS TYPE OF WORK WI�L BE COMPUED
WITH WHETHER SPECIFIED MEREIN OR NOT, THE GRANTING OF A PERMIT S6�OOO $3.00
OOES NOT PqESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEI THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OF LOCAL LAW REGULATING CON-
STRUCTION OR THE PEAF A E OF CONSTRUCTION. $SC�. �JO
P AN CHECK FEE TOTAL FEE
�
ro � - � 1 Ss9.5o
GNATUREOFCON7R OAORAUTHORIZEDAGENT IDATEI WHEN PROPERIY V ATED THIS IS VOUR PERMIT
��
SiGNATURE OF OWNER �IF OWNER BUILDER� 1DATE1 BIDG �NSD aTE
�---
xEw [ 1
ADDN. [ ]
pLTER. [ �
City of Fridley
R-1 A1tD R-2
Building Permit Applieation
Construction Address: �P�
!L �i QC, l (�
Effeetive 4/1/86
Legal Description: �
Owner Name & Address : 05 � �� 7 � `v d Tel . # `r
Contractor:
i �- h.J m N� so ,-S Tel. # 7�/- S�
Address• �/3 l�� NT2�9 � Al�- 15 ^J S�� �
Attach to this application, a Certificate of Survey of the
lot, With the proposed construction draWn on it to seale.
DESCRIPTIOIi OF II�PaOYBNEI3T
LIVIpG AREA: Length i�idth Height Sq. Ft.
GARAGE AREA: Length width __ Height Sq. Ft. _
DEC1C AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [] Inside Lot [ l Ft. Yd. Setback Side Yard Setback
Type of Construction• �t � M �v : y- �- (I AsC� t� Estimated Cost: �_ G� B'° a-°'a --
� 9! '7 /L� �
Approx. Completion Date: � � ��-�^A� - --
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation
DATE: �� � 7 ` � ?
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAI.
STIPULATIONS:
APPLICANT: � Tel . ���� �S^y �
CITY IISE ONLY
� •S �o - S� Fee Schedule on Reverse Side
$ 25x of Buildiag Permit Fee
� 3.0 C� a•50/�1,000 valuation
� �475 Per SAC tTnit
� Fee Determined by Engineering
$ Agreement Necessary [ l Not Neeessary [ 1
$ s � S�
�
SuBJECT
City of Fridley 2 6 6 3�\
AT THE TOP OF THE TWINS B U I L D I N G P E R I T
�
� ` RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV. / (� ��
r � v � PFOTECTIVE INSPECTION SEC. �� �
� _ �
' �'�'1 � CITY MALL fRIOLE� 55�32 NUMBER REV OATE PAGE OF APPNOYEO BY
�°"� � �'' 612-571-3450 9t0-F15 / /
i 14 98
108 ADDRESS 6172 Heather Circle
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACMEO
DESCR. 3 1 Heather Hills West SHEET
2 PROPERTV OWNER MAIL ADORESS ZIP PMONE
Tom Elwell 571-1076
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LiCENSE NO
Walker Roofin 2701 36th Ave S. M ls MN -
4 ARCHITECT OR DESIGNER MAIL ADDFiESS ZIP PHONE LICENSE NO-
5 ENGINEER MAII ADDRESS ZIP PHONE UCENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION �7 REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Roof re air- storm dama e
9 CHANGE OF USE PROM TO
STIPULATIONS
iinderlayment must comply with State Building Code.
SEPAFiATE PERMITS ARE REOUIqEO FOFi ELECTRICAL, PLUMBING, HEATING, TYPE Of CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULI AND VOID IF WORK OR CONSTRUCTION 20NING SO. FT. CU. FT_
AUTHOfiIZED IS NOT COMMENCEO WITHIN 60 DAYS, OR IF CONSTRUCTION
OF WORK IS SUSPENDED OR ABANDONEO fOR A PERIOD OF 120 DAVS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFV THAT I HAVE fiEAD AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL PROVISIONS Of LAWS VALUATION SURTAX
ANO ORDINANCES GOVERNING TNIS TYPE OF WORK WILL BE COMPLIED $5OO �.SO
WITH WHETHER SPECIFIED MEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOIATE OF CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR IOCAI LAW REGULATING CON- $21 . OO Fire SC �. SO
STRUCTION OF THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTA EE
License S 5.00 $ .00
SIGNATUREOFCON�RACTOAOpAUTHOp�ZEDAGENT IDATEI N P PER LIOAT THIS �S VO+�ERMtT `
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S�GNATUAEOFOWNEAi�fOWNEQBU40ER� �O�TE� �g �� q�7E
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ConstructionAddress:
Legal Description:
Owner Name & Address:
Contractor: � ,� �1 �
Address
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
�
Effective 1/1/98
Q�a��3�
�
MN LICENSE #
Tel. # ���' a� 3��
�
Attach to this application, a Certificate of Survey of ttie
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length dth Hg ound Sq. t.
�� ��,-- �� � ;�,-�� � - ��� ��� �'��J�
v
Constniction Type: - + stimated Cost: $ � �` `� �
� (Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x� =$
DATE: l`t'f J APPLICANT: Tel. # �
Permit Fee
Fire SurGharg�
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$����� Fee Schedule on Reverse Side
$ � � .0(?1 Qf Permit V�luation (1L�Oth%) _ _
$ � $.50/$1,000 Valuation
$ $1000 per SAC Unit
$S -�j . �O $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [] Not Necessary [ J
', • �'�
fli� �'�`S� 7 8
sus�ct. PER
City of Fridley S 913
�
�T TNE t°P °F 'ME TW'NS g U I L D 1 N� P E R M I T
� ` RECEiPT NO.
' � �: ----- �
COMMUNITY OEVELOPM�NT DIV. ���
r � •� PROTECTIVE INSPECTION SEC.
1 .1 �
l.--.�; ����;.� CITY HALL FRIOLE� SS13Z NUM�ER pEV OATE P�GE Of •rvnO�EO !r
t 612-57�-3a50 s�aF�s 2l11/99 / /
J08 ADDRE55 6172 Heather Circle NE
t LEGAL �OT NO. BLOCK TRACT OR AOOITION SEE ATTACMED
oescR. 3 1 Heather Hills West SNEET
Y PiiOPERTY OWNEfi MAtL A008�S$ 21P PMONE
Tom Elwell 6172 Heather Circle NE 571-1076
3 CONTRACTOR MAIL ADORESS ZIP PHONE LICENSE NO
Rainbow Restoration 9741 86 Ave N, Maple Grove, MN 55369 493-8420 8703
4 ARCHITECT OR OESIGNER MAIL AOOqESS 21P PHONE LICENSE NO.
5 ENGINEER MAIL AODFiESS 21P PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WOHK
O NEW O ADDITION ❑ ALTERATION �] REPAIR p MOVE O FIEMOVE
8 DESCRIBE WORK
Reroof House & Garage (63 Sq) Tear—off
9 CHANGEOFUSEFROM TO
STIPU�ATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST. OCCUPANCv GpOUP OCCUPANCv lOAO
SEPARATE PEqM�TS ARE REOU�RED FOR EIECTfi1CAl. PIUMBING. MEATING,
VEN71lA71NG Oit AIR CONOITIONING
THIS PERMIT BECOMES NUII ANO VOID If WORK OF GONSTRUCTION IONING SO. F7 CU FT
AUTHOFIZED IS NOT COMMENCEO WITNIN 60 DAYS. OR IF CONSTRUCTION
OA WORK IS SUSPENOED OR ABANOONED FOii A PERIOD OF 120 OAYS AT
AN� TIME Af7EN WORK IS COMMENCED. NO OWLG. UNITS OffSTREET PARKING
I HEREBV CERTIfV TMAT I MAYE REAO AND EXAMtNEO THIS APPLIGATION 1 STA�LS GAFAGES
ANO KNOW TME SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF �AWS yA�UATION SURTA%
ANO OfiDINANCES GOVERNING THIS TYPE Of WORK WILL BE COMP�IEO
WITH WHETMER SPECIFIEO MEAEIN OA NOT. THE GRANTING OF A PERMIT �5,399 �2.%O
DOES NOT PRESUME TO GIVE AUTHORI7Y TO ViOLATE Op CANCEI TME pEpMIT FEE $AC C RGE
PROVI NS OF ANY OTMER STA7 OR IOCAL LAW FEGULATING CON-
STpU TI OR TME PERf09MAN OF CONSTRUCTION �LIZ..ZS Fl @ SC �S.�FO
r PLAN CMECK fEE TOT � EE
�� Licen SC $5 $125.35
S�GN�TUpEO�CON"A�CTOpOp�UTMOA�ZEDeGENT i0 E� H P VAl1D TMIS IS VOUR PE/RM�IT
I '/� ! �
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ConstructionAddress :
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
��t � r �i'�•
Effective 1/1/99
��� �
� ��
�
Legal Description:
Owner Name ddress: � Tel. # S%� �d 7�
Contractor: i �N `o MN LICENSE #��C�7 ��
Address: ���� �� �, ���lr.��i� �t�U� _Tel. # �'%93 � ��C�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale. �
DESCRII'TION OF IlVIPROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length Width Height
DECS AREA: Le gth Width Hgt/Ground
01'HER: �--V`[TO F ��� ct� ��G�.�p i
Sq. Ft.
Sq. Ft.
Sq. Ft.
- ��� a Ff
Construction Type: Estimated Cost: $ �����'%
(Fee Schedule on Back)
Driveway C�ub Cut Width Needed: Ft. + 6 Ft = Ft x =$
' s
DATE: � �� ��iPPLICANT: � Tel. # `/ � �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Fscrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ � �_ �.� �Fee Schedule on Reverse Side
$ �. D .001 of Permit Valuation (1/lOth%)
$ . �O $.50/$1,000 Valuation
$ $1050 per SAC Unit
$ ,� �(J $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ ��5-��`
._ .�.