P - 39349From: unknown Page: 2/2 Date: 9!6/2011 9:39:47 AM
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�uilding BT.TILDING Permit No.: �I
lnspections �����p���'�� AFPLICATION Received By; .1V i,� '
763-572-3604 C�TY ('1k' �'�I��EY' Date��: � � �' � � � "�
7b3-S02-4977 FAX �,rr�CrtVti i-t-2011
DATE ���� ���' _,,, ___,,._ Y�l.)i2 F.-MAIL anDRFSS
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srr� A�uK�ss G 7r �e t,�. ;�7 �� �'��� fey /hn �Sils'.Z
1TQ5 APPLICAN'f I5: �� OwNEk OCC�rrrR,�c�rpR
PIit7P�Yt1'Y I�WNER/ N.v�,t�.: iI� ��a
TENANT AD�RESS: G.7( �C-�P�tc. l�/ rlc--- , Gi1Y �` P� �sTnTEr'�1 ziP 5„���3ar
PI�ONE: if�. ��� o�li �e2 --- ^- --
CUNTRACTOR N�MF;
SUFSMTT A COFY OF STATE LtC�tdsL� JF .
YUUR S'FATE LICF.NSii -...-_.-.. ,...._.__.__�._ ._-.....I.EAn CF..RT NL111�ER
ANll C�R'flr'iLA'FE C7F AUURF„55: CPTY�,,_ _,,,_ STATE ZIP
[NSU�C�+ FiIpN� NAx
PRCyPE1tTY TYPF �TSIIVGLC CAA,IILY/NEW CANS��x��Cru)N svF
0 7WU NAMILYMF.W (;(7NSTRUC[TON 3TORILS
PERMIT TYPE ��ll���<�tv fl GARAGE/SHED o wINDOWS
ORASEMENTFfNISiI �ROOr ❑llRAIN'fiLFi
G DECK ❑ StUING ❑ c)l�-IF.R
❑ SW1MMtN(i PpOL
T'YPE U� WOItK: ❑ NEW HUM�: GC)NS'I'R(,1('TIQN ❑ nnrn�qx
❑ MAINT�NqNCFJREpAIR ❑ R�MODELING
DF,$GAIAfi W�RK AFiJN�rp�NE:
SIZE OC I1�RdVL'IvIENT' I.F.NCiTH WIpTH II�IGIIT 5< FT
Rt 1�' • O,�iOUSE ONLY
NI]MI3�Jt ()F SQUARF5 �� 1ffi�IOUSC & GARAGi i�►$�M�N7' Kk.tilAUEsI.iNf3 SLfH1vFiT:
1, F.xistingElporPlan
� �ATTAGHF.n GARAGF. 2. Ftopose�t pvurplm�
PAQP�S�d Sl��:__, �.� 0[}ETACiIED GAitAGE 3. Lisi Uf shuchaal mcmbcrs to be used
PRUP(1tiF13 Hfs1CsHT;
�p�� � FORNEW CONSTILUC1TdN INCLUIiI'NC,i 17F.[:KS,
❑ Vuryi CSp�t
ADDITIQN3 $ �2�H�.1 ST7RMIT•
0 Aluminum ❑ Trim i. 5irc PlenlSurvey showing Use existing sEru�!►acs
G Other [] Favcia � M�� t�i�
2. Twc> sels uf conlructicm pians
�Q}� 3. �ncrgy Catculations
IN E7(ISTING OPGN[NCS I�Yes �No LOCA'[1dN OF WINUUWS POR WQ�IDOWS -PRQVIDi U-YRLUti AND
' OR POR NIiW OPfl�tINGS-D�SCIUk3E Slz� c)!� M�4MTI'ACTUR� STICK@K t)N W INIJ()W,
OPtiNINEi CHAN(i� d�
TYPE OF WINDOW TO HE INSTALL�D NUMSEIt ON W 4NllOWS
AI,I. FEES AR� $AS�D ON VALUATION. INCLUDING THE CC?ST OF LABiiR AND MATERIA�S:
1il
Plan Review
Fire Surcharge
Surcharge
License Surcharge
S�C Char�e
Curb �ut Fscrow
Erosion Control
Park f�ee
Sewer M:ain Charge
(USING THE 1997 U.R.0 FF.E SC�(k',DULE)
See i3ACk P�ge for ree Scheaule
65% of Building Permit Fee
A01 times the totai job valusrinn
.000� x Permi! Valu$lion Minimum �5.00
$5.40 (5tat� Liu,-n�cd Rc.�sidcntial Cc►rtr�ctc�rs)
527.30 per SAC Unit (Plans to MWCG f�r determi��tion)
�+6 R= ftx 525=$
$4S0 Conservation Plan Review
Fee Detsrmined by Engineering
A�ernent necessary ( ) Non Necessary ( )
'i'F115 I3 AN APPLICATION FOR A FERMIT-NOT VALID UN7IL PKOCESSED
Y 8tasby apply [or a building pem�it and i acknowlecige that the information above is compl�te end accurstt; that the wark will be in
ccsnforrtt�nce with the ordinances and codes of tlte Ciry of Fridlty aitd with the Minncsota C,onstruction Codes; that I understand iltis is not a
perrnit but oi�ly en application for it d work is nat to start withaut a permit on site; that the wark witl bc in accordance with the
approved ptan in the E�e of requires review and approval af pl D
SI(iNA7VRF. UF APPt.IC.ANT , � PRIlVT NA14� ��� ' .� � +�� UA'I'F: ( � �r 2ai�
AND MECHANiCAL, WORK : ' .'