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ADDN
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Construction Address:
Legai Description:
Owner Name & Address:
Contractor: �
Address: .l �,�
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Tel. #
Effective 1/1/2001
(763) 572-3604 Bldg Insp
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MN LICENSE #
Attach to this application, a Certificate of Survey of the
lot, wiih the proposed construction drawn on it to scale.
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
Width
Width
Width
Height Sq. Ft.
Height Sq. Ft.
HgUGround Sq. Ft.
Construction Type: Estimated Cost: $
Driveway Curb Cut Wdth Needed: Ft. + 6 Ft = Ft x$ �! _$ "7' ���
DATE: � �� D/ APPLICANT: � Tel. # t0�� ' �� �C�'Y��
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if maiting in application
Permit Fee -- $ Fee Schedule on Reverse Side
Fire Surcharge $ .001 of Permit Valuation (1l10th%)
State Surcharge $ $.50/$1,000 Valuation
SAC Charge $ $1150 per SAC Unit
License Surcharge $ $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary []
TOTAL
STIPULATIONS:
$
Mark Conrath
•' Edina, MN 55435
' Phone: (�52) 831-4300 Faz: (952) 820-2340
:Y iAA
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*� -
INSURANCE �
OWATONNA • ATIANTA • PHOENIX
sus�etr PE
c�ty of Fr�aley 3 � 6 a 6�
AT TME TOP QF THE TWINS BU I L D I N� P E R M I T
r
� ` R .
•
COMMUNITY OEVELOPMENT DIV.
� j V �".� . . .
J � � PROTECTIVE INSPECTiON SEC. /� / �
i----�; �"' �•� CITY MALL FRIDLE� 551�2 NUM�ER pEV O�TE ��GE Oc AVVROVED 9r
t 612-57�-3450 9�aF�5 3/19/O1 � �
lOB ADpRE55 � Heather Place NE
t IEGAI �07 NO. BLOCK TRACt OR A001TION SEE ATTACNE�
oesca. 2A, 2B 1 Heather Hills North SHEET
2 PROPERTY OWNEii MAIL ADDRESS 21P PMONE
Kootenia Homes 7975 Afton Rd, Woodbury MN 55125 651-731-2345
3 CONTRACTOii MAIL AODRESS ZIP PHONE LICENSE NO
Same 20060346
t ARCMITECT OA DESIGNER MAtL A��RESS ZIP PMONE LICENSE NO
5 ENGINEER MAIL ADDRESS tIP PMONE IICENSE NO
6 USE OF BUIlO1NG
Residential
7 CIASS OF WORK
C� NEW O ADDITION O ALTERATION D REPAIR O MOVE O REMOVE
8 OESCRIBE WORK
Construct a 41'8" x 43' Dwelling; a 20' x 22' Garage; a 14' x 12' Porch; and a
1 x Dec c
9 CHANGEOfUSEFROM TO
STIPUlAT10NS See notations on plan. Provide City with copy of verifying survey
before capping. Provide a hard surface driveway. Provide sod in the front and
side yards. Paid park fee of $1,500.00.
Sewer & Water Locations: See City Engineering Dept.
V1/ARNING SEPARATE �'�RN���`�
Before digging cali fof REQUlRED FOR:
aii utility Iocadons ' PLUMB� NGG� ANDnSf GN�
454-0002
REQUIRED BY LAW
TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE RE�UIREO FOfi ELECTRICAL, PLUMBING. MEATING.
VENTILATING OR AIR CONOITIONING
THIS PERMIT BECOMES NULL ANO VOIO IF WORK Op CONSTRUCTION ZONING 50. fT CU fT
AUTHORIZED IS NOT COMMENCEO vyITMIN 60 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANDONEQ fOR A PERI00 OF /20 OAYS A?
ANY 7iME AFTER WOiiK IS COMMENCED NO OWLG. UNITS OffSTpEET PARKING
I MEREBV CERTIFV THAT 1 MAVE REA� ANO EXAMINEO TMIS APPLICA710N 1 STA�LS GAHAGES
AND KNOW ?ME SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS Of LAWS VA�UATION SURTAX Fire SC
AND OpDINANCES GOVERNING TMIS TVPE Of WOpK WI�� BE COMP�IED
WIT►i WMETMER SPECIFIE� MEREIN Oii NOT. TME GRAN7ING OF A PERMIT $259,669 �129.$O 259.70
DOES NOT PiiESUME TO GIVE AU7MORITV TO VIOlA7E OR CANCEL 7HE pERMIT fEE SAC CHARGE
PROVISIONS OF ANY OTMER STA7E OR IOCAI LAW REGULATING CON-
STRUCTION OFi TME PERFORMANCE Of CONSTRUC710N � 1 � HH9 . 7S � I,150.00
P�AN CMECK FEE TpTA� FEE
$5.00 '_,icense SC $3,434.25 + PF
SiGN�TUAEOf�QN'AACTOpOp�UTMOQ�2ED�GEN1 iD�iE� ME PpOpERIY VALIOATED TMIS IS YO PER iT
� ��� �
TUpEO�OWNE U�� EA� iD�TE� �pgD - r��TE
{ �
NEW ..:;,,� I I
A�I�`� [ ]
ALTER ( j
Effective 1/1/2001
CITY OF FRIDLEY (763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: ��� J? ��.-�z�cZ p�«
Legal Description: �-oTS �A � 2�3 ��f�C � �4�z�.cz, ,���s 'tJc,a.-�ct
Owner Name & Address: 1����A ��G� Tel. # 6S\- "1'3t -Z'34S
Contractor. ��zt.��A ��.� MN LICENSE # z�6�0�
Address: Za"15 A�o�_ CZ� V��,�.� ME�I � 55 � ZS Tel. # 6 s� - � 3� -Z-3�S
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
���,
LNING AREA: Length
GARAGE AREA: Length �
-BEE�lE�kRE�t: �o1LCN� Length �
�: � � r�
DESCRIPTION OF 1MPROVEMENT
Width .� �
Width °?°'�
Width ��'
�
Height �� Sq. Ft.
Height Sq. Ft.
HgUGround Sq. Ft.
a 5 9 l�(o Y• 7d
Construction Type: 'I�\Ew ���7�T1 � Estimated Cost: $ 313 � �� � �
Driveway Curb Cut Width Needed: �Ft + 6 Ft = Ft x$ �$
DATE: 3- �\' � APPUCANT: --,cs� � ��r�..A Tel. #�S\-'1'3�-'L3�S
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$� g g�'� %s Fee Schedule on Reverse Side
$ � � 7� .001 of Permit Valuation (1/10th%)
$ l a , g0 $.50/$1,000 Valuation
$ l I S0, DO $1150 per SAC Unit
$ S� OO $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ �O Q Fee Determined by Engineering
$ Agreement Necessary [] Not Necessary [ j
$ �-�9 � � �
M1�2-12-2001 10�25 E.G.RUD & SOhtS INC 612 766 6007 P.02i02
����'� ( ���� � ����� o����
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FOR: KOQTENIA HOMES �0�"�'4
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OVERNEAD WIRES �---:
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1—!�A 7"l�-1� PLAC�
(9 � POUR£D CONC FOUNDATION)
DIAG: 54.0 X 8?.0=106.88 LOOKOUT WINpOWS
G� Denotes Proposed Erevatlon. PROPOSED ELF�/�roN�,s-
x�o��.2' Denotes Extsting Elevo{;on, G,4RAGE FLOQR = 916.1
� D�notes Dfrection of pralnvge. TOP OF 6LpCK = 916.5
Der�otes Nbor! Hub at 1t' foot olfset. �g��r FLbOR = 9p7_8
OF FOO7)NG sY 907.5
L.OTS 2A dc 2B. BLOCK i. HEATHER HIU.S NORTH. AIVOKA CUUN7Y, MINNESOiA,
•— -
Scole 1"s�,,' e pMOtes Iron Mvnument 8eorin Ootum: As=umed ,1
I hereby certify thot this plan. �urvey or report wos prepored by me
or under my direct aupervision cr+d that I om o duly Licensed Land
Surveyor under the lowa of the State of Minneaota.
�I�t�d/: �SV�d�C �,/O�C CueA�iON E, R�N� N�i�
8��.
Dated this,� day o� L''��� 2001 Minn�rsoto License No. PioB
t. c�. �ur� � �s, ��
{.�4NIC Fdrll!'vEYORB
til� I.�KINCiTON �►vE. NO.
criRCL! PIN�S, MIIWl��TA
�14-3�+T8
'f�L.l'ib:lJ 'tdb•99�6i�
Tar� P. e2
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4
MNCheck COMPLIANCE REPORT
Minnesota Energy Code
MNcheck Software Version 2.0
Minnesota Department of Public Service
1-612-296-5175 1-800-657-3710
COUNTY: Anoka
STATE: Minnesota
ZONE: 2
CONSTRUCTION TYPE:
DATE: 3-12-2001
Single Family
DATE OF PLANS: 3-12-01
TITLE: Fridley Parade
PROJECT INFORMATION:
xxxx Heather Place
COMPANY INFORMATION:
Kootenia Homes
COMPLIANCE: PASSES
Required UA = 718
Your Home = 670
Permit #
Checked by/Date
Area or Insul Sheath Glazing/Door
Perimeter R-Value R-Value U-Value UA
-------------------------------------------------------------------------------
CEILINGS: Raised Truss 1983 44.0 0.0 44
WALLS: Wood Frame, 16" O.C. 3114 19.0 2.0 161
GLAZING: Windows or poors 565 0.350 198
DOORS 63 0.340 21
FLOORS: Over Unconditioned Space 13 38.0 0
BSMT: 9.0' htj6.0' bg/9.0' insul. 1603 11.0 102
SLAB FLOORS: Unheated, 42.0" insul. 210 10.0 144
-------------------------------------------------------------------------------
COMPLIANCE STATEMENT: The proposed building design represented in these
documents is consistent with the building plans, specifications, and other
calculations submitted with the permit application. The proposed building
has been designed to meet the requirements of the Minnesota Energy Code.
Builder/Designer ���C�S`t� �� / � ,�,,,� \ ��_ Date 3 � �2-�.j �
4� .
`• NEW HOME FIELD INSPECTION
ENERGY CHECKLIST
MINIMUM REQUIREMENTS
(CATEGORY 2)
FOUNDATION:
[ ] Exterior foundation wall
insulation installed:
R-
[ ] Slab-on-grade insulation
installed: R-
[] Ducts in slabs have R-5
insulation bottom and sides
PENETRATIONS:
[] Window and door frames sealed
[] Framed wall openings into attic
sealed
[] Other joints in wall sealed
[ ] Dropped ceiling air-blocked
[ ] Plumbing penetrations sealed
[ ] Exterior walls behind tub
and shower sealed
[ ] Plumbing vent stack sealed
[] Chimney flues sealed at ceiling
[] Perimeters of all grills and
registers sealed to vapor
barrier
[ ] Electrical service sealed
[ ] Recessed light fixtures sealed
[ ] Wire penetrations into attic
sealed
[ ] Telephone, cable TV
penetrations sealed
[] Fans sealed where vapor barrier
penetrated
�
OPTIONAL
(CATEGORY 1)
[ ] Foundation rim joist sealed
airtight
[ ] Upper story band joists
sealed airtight
0
[
] Ceiling poly sealed to top
of interior partition walls
] Electrical boxes sealed to
vapor barrier
[ ] Fan housings air sealed
� �
'•� NEW HOME FIELD INSPECTION
ENERGY CHECKLIST
PAGE 2
MINIMUM REQUIREMENTS
(CATEGORY 2)
INSULATION:
[ ] Vapor barrier installed
[ ] Interior foundation wall:
( ) Vapor barrier installed
( ) Insulation installed: R-
( ) Moisture barrier installed
[ ] Attic insulation installed:
R-
[] Attic card posted with proof of
bags installed
[ ] Floor insulation installed:
R-
[ ] Wall insulation installed:
( ) R-19 ( ) R-21 ( ) R-
WIND WASH BARRIERS:
[] Wind wash barrier installed at
attic edge
[ ] Overhangs (cantilevered floors
and bay windows)have wind wash
barriers
MECHANICAL:
[ ] Ducts running outside conditioned
space sealed and insulated
with minimum of R-8
[] Returns in same space as furnace
sealed
[ } Ducts in unheated spaces
[] Water heater has pipe insulation
or heat traps installed
[ ] Furnace AFUE:
[ ] Central Air SEER:
OPTIONAL
(CATEGORY 1)
[ ] All exterior joints in
building envelope sealed
[ ) Residential mechanical
ventilation slrstem
installed (Mandatory if one
or more item in this column
is checked)
----NOTES TO FIELD (Building Department Use Only)-------------------------
. .
MAR-15-01 THU 16�23 KOOTENIA HOMES
�OO�lC�11.
M
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FAX N0, 16517312314
P, O1
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��S1GN�R5 ANp I3UlLARRS' 7975 ARon Road 'I�VoadburvLMN 5512_ S (651 ?31-23�a
F�x Mexno
TU: ��+Nlb ��, FROM: ��� lrl'ti'�I�{.�.��
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FAX#: FAX#;
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651-731-2314
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KOOTENIA HOMES
FAX N0, 16517312314
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MAR-13-01 TUE 16�19 KOOTENIA HOM�S FAX N0, 1651�312314 P,O1
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---.,.._.� -- -� ..-... _ �. _�,
n�S1GNF,RS AND Rir.CLDERS _ 7975 Atton Road, wnodbur� MN 5�125^ (65t1731 23�5
Fax Memo
TO: _�l� �,�SS��. FltOM: �'�
CUMPANY: OFFICF, #: 65]-73l-Z345
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F - FAX#: 651-731-2314
^�yF•7r�°'T� � f: ^��:Fr-++�
DATE: � ' � 1 � l�"'�,....,�.......--
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MESSAGE:
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�AR-13-01 TUE 16�19
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TO:
KOOTENIA HOMES FAX N0, 16517312314 P.02
o��tai�4 JL 4�1I1'E CO PAGE 01 �
C�t'�T� N IA
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��i�nera & Bu�tdi
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6$1-731 �346
65�-7'31-2314
^ �a yome$ has just completed workir�9 dr�;ngs fiae, a new home �o be bupR a� the
ab address, You �re (nviter! to subm� a� hId for this
8ids aA tre �urned to us within one (9) week of the date of thi��req�e�. �°sed plans.
Bidde shall p�mppy �#y ��la Homes o� any ambiguity� inoon�t
�Y Y discover �r� there eocamination of the p�ans, specit�bons, and t�he��emor which
�on�' ns.
S�oof
Ca/1
0
Jarnie
refer #o th� p���� Rumber in y�our bid and any othe� oorr������,� M,�� �s,
Is fo be perfcxmed �s foqa�ws:
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Ct1Y0E
FRtDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
September 28, 2001
Kootenia Homes
7975 Afton Rd
Woodbury, MN 55125
Re: Final Inspection at 6203 Heather Place NE, Fridley, MN
Dear Sirs:
A final inspection was conducted on September 28, 2001 for the construction at the
above noted address. We found that the construction complies, to the best of our
knowledge and belief, with all the requirements of the building codes of the City and the
State of Minnesota relating thereto, and permission is hereby given for the occupancy of
said dwelling.
If you have any questions on this matter, please feel free to contact me at 572-3602.
Sincerely,
RON JULK W,
Building cial
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ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSIT'S� AVENUE NE
FRIDLEY, MN 55432
s�i-36u4 r��:
: 6203 HEATHER PL NE
: T000065
: HEATHER HILLS NORTH PLAT 2
: LOT 2A BLOCK 1
: ELECTRICAL
: RESIDENTIAL
: ADDITION/ALTERATION
s�i-li��i
PERMIT NO.: 2004-01754 �
��
DATE ISSUED: 10/OS/2004
VALUATION .
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL A SAVERS SWITCH.
# INSPECTIONS 1
APPLICANT
HUNT ELECTRIC CORPORATION
2300 TERRITORIAL RD
ST PAiJL, MN 55114-
OWNER
REBECCA KLANDERUD
6203 HEATHER PL 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 lrnow the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
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
ELEC PERNIIT FEE - MIN (RESI)
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WIT'H CHECK # 118132
Sr;YAKA"1'� Y�KMi"1'S Kr,QU1R�D FOR WORK �THER THAN DESCRIBED ABOVE.
20.00
0.50
20.50
City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287
6431 University Ave NE
Fridley MN 55432
Mechan�cal Permit # Zcx'�-��I
Residential Application
City of Fridley
%�Z� o� See Back Side For Required Information �i �Z�fS -v�
Date Site Address:
The a licant is: (cirlce one) Owner Contracio
Properry Owner. �cc k/ �le�
Address: �1 � i-1r�t/" �<<
C�y: State: Mrv • Zip: "� S �
Phone: - - IL� Cell: Fax:
Corrtractor Informat'�Q n
Company Name:,��'C.SdG NPo.�f�, � �
Contact Person: C' Inr;s R�d�r
Address: Z�vv Fi.r�.�v�• p..t .
Ciry: �e�,!/� State: M N' 7rp: ��/� �
Phone: /2-3 63 - 6"�/ 6 Cell: Fax:
Email: MN Bond# & Ex Date �S ! Zc�(o�
T pe of Work (circle one : Re lacement AtteratioNRemodel
Detailed Description of work: �,�('h�p/.rc� �
Equipment Installed: MFG: Model: �s�x •�61�u Size/BTU: :� y, o�
MFG: Model: Size/BTU:
MFG: Model: Size/BTU:
P4ease check afl that apply: _Fireplace (g $15 _New Gas Grill $10.00
_A/C $25.00 _Fireplace (wood) $35.00 Gas Unit HTR $10.00
Air to 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
Permit Fee $ �S �`� (Total from above-Minimum fee $35.00)
Surcharge �. ^ 0.50
Total Due $ �' S� Make check ayable to C' of Fridle
This is an application for a permit- not valid until processed
I hereby apply for a mechanical permk and I acknowledge 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 ConsVuction Codes; that I understand this is not a permit but only an application
for a permit and work is not to start without a permi� that fhe work will be in accordance with the
approved plan in casa of afl work which requires review and approval of plans.
Signature of
Approval Ins
Date:
Date: �
Please Note: Separate permits are required for Building, Plumbing, and Electrical work
Building
Inspections
763-572-3604
DATE � " d'c
SITE ADDRESS �
THIS APPLICANT IS:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
� OWNER �ONTRACTOR
PROPERTY OWNER/ NAME�e. �eCL� iC��j��/'tk]�
TENANT ,�DRESS: �o�-O 3 /�ect �,al /�/4 c� C�7'Y
PHONE: l�'1D.3�s7� a,� a/
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
Permit No.: o,
Received By:
Date Rec'd: �� ����`�'
'nTe�/LtP ss y3o?
STATE LICENSE #�s y6a e 9 E3� DATE 3^3/-0 ?
ADDRESS: � �f� CiTY �ICI✓�1 �t%%�STATFl�i'�P��3
PHONE '7� �^5��� "'�/.3�0 FAX `%�03'� ��%.3%I
PROPERTY TYPE � SINGLE FAMILY/Nl
❑ TWO FAMILYINEW
PERMIT TYPE
TYPE OF WORK:
❑ ADDITION ❑ GARAGF/SHED ❑ WINDOWS
❑ BASEMENT FINISH �OOF ❑ DRAIN TILE
❑ DECK SIDING D OTHER
O SWA�Il�IING POOL
DESCRIBE WORK BEING DONE: �e %'Q�j �
SIZE OF IMPROVEMENT_
ROOFIIVG
TfUMBER OF SQUARES �L
GARAGES
PROPOSED SIZE:
PROPOSED I-IEIGHT:
SIDIlVG
O Vinyl
❑ Aluminum
❑ Other
LENGTH WIDTH HEIGHT
[�'HOUSE & GARAGE
� ATTACHED GARAGE
0 DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
WINDOWS
IN EXISTING OPENINGS DYes �No LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENMG CHANGES 8c
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
Ft.
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project
2. Two seu of construction plans
3. Energy Calculations
TYPE OF WWDOW TO BE INSTALI,ED NUMBER OF WINDOWS �
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $.�`'r� i�e �o�( ,^ OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
I Erosion Control
, Pazk Fee
� Sewer Main Charge
Total Due
$
� Cn . ale
s 3• )3
� S-�
$
S
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuarion
.0005 x Permit Valuation Minimum 5.50
55.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftxS2l=$
�450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks oavable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I herehy apply for a building permit and I aclrnowledge 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 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 whic ires review and approval of plans.
i, SIGNATURE OF APPLICAN��Ces� i'�" r PRINT NAME /�� %!'� DATE ��� '� �/