P - 367373t�ild�rig
1�.S�7�C��Q1,�S
���-��2��6oa�
ATE `,� ! - ! 1
ITE ADDR�SS,_
Ff[S AhPLlCAN1` 15:
From: 7635742044
Page: 2/2 Date: 5/17/2011 9:14:55 AM
�������
l�ermit No.
��������'��� ���"X..��.E���Q� Received �y:.A� ��
.. �.y-.r �
Cx'�'�' O�' �'�DL�Y ��`���kl�l" .�. '���
YQIiR 6•T+�AII. ADDRESS ����� �"` Q C�+�o tr. �tei.� -� c-( qr+r� I�r ti't'i'. Cd�
ic(tpr'Y I�r lV � - _...
CIOWNER �COM�CTOR
�R'a'X OWN��iJ Nal�r&: �� t�'� Wlc C�x w � v-�
TENAN'� nnn�ss: � ci� S'tA��P
�or,E: C7w3� �" 7 E- S�� 3
SUBIv�I'�' A GpPX O�
�OifR STAT� LICENSE
WTI'kI A.PPi.1CA7`IO�1
�'x��
�P$ oF wonx:
srArE uc�rrss ��p b7 Z EXP DATE
ADDRESS: w
t�ts�rte te3>S�'�'-2�JS4 �axC�G'3.� S'
ti snaat.� Fa,�.vrnrEw ccm�s'�ttucxtot� s�
�'J'iW0 �'A_1'�1_L_11.IN�:W CdNS7'�tUCriS7N STi
0 ADbT['fCN 1�'tiAF�A�3E/SF�p
f� BASF.iv�N'T F[N13H Cl ROpp �
CI a6ClC ❑ SID�htt�
� 5W2MMING PC�(3L
�E3CRI88 WdRK BEINC3
un�s� OF s�v,+�s .
�
tOP�Ci3ED 5lZE:
2pPDS�D HEi(3F�I :
�IIV.G
Vi�yl
Alqlf13AT1B1 �
�Ip�.�� .
���Q OP�ih1�5 �Yes I�No
R FOR NEW �DFENWtiS-bBSCRI�E StZE Of
?p�1A+1Q C�ANGFS b!
�
O HOUSE dk OAIRAGE
l] ATTACHED QARAG�3
o, ��r,n� a�u.ac��
Clsoffie
� Trittt
❑ Fasein
'I70N OF WINDOWS /E+7�r.6i/�r
.Auat� . l�/MI.�r .
�+�w.l�p� s�',as�►t+�rn�*"�S
r
■i 4 ■wn
��s
xNDOwS
17 i>RAIN'T1LE
1] O'CHER
t�•1�S �+�.
i. Exiating Floar Pi�tf
Z. Fraiposod 41oor plm�
3, L.ict of �truta�re! menlbers to be u�ed
.
FQR Ti�W CONSTkUCTION lNCLUDiNO bECKB,
�tJDrr�o�s � aoRCH.��^, ic�B1�f17�
i, Site PtaNSurvcy showfAg tho acisting serucauraa
� P�� PrRioa.
2'. ?wo se� vif con�ru�ion pleac
3. En�,y6)alculatioe�
,�►x,� ��s a�� a�,s��a orr v�v�.�vN, nvcz�v�r,�� �� cas�r aa� z..�,80�. Azv�a
(tJSLNG 'i`i.�E 1997 U$.� k�E SC��k1UL�)
't'dTAL JOi3 'V�,L'U.A�T�O�V � 1a�5 `'E OCCUP�,NCX 'I'XP
�rmit Fee
laa Rcvicw
ire Sv�rc}�srge
�rcixarge
icense Surcharge
AC Gharga
urt� Cut Bscrow
�sion Controt
uk �ce
:wcr Main Charge
__. -
�
�xt�.�,..s:
See aack �age fbr Fee SchedulC
b5�o of Building Pcrmit Fcc
.00] times chc saraf job valuation
.Q005 x Por,p�it Valustion Minimum �.SO
$SAO (Statc Licenscd Rcsidcntial Contractors)
�X6'l5 pc�r SA,C Unic (�lans to MWCC fbr datermination)
#t+6ft= �ix$21 ��,�
$450 Ca�aserv�tion Plan �eview
Fee Detenaained by �ngineerin.g
Ag�reemeni naccssary ( } Non Ncaessary ( )
TH1$ fS AN APPLICATlpiJ POR A P�RMCi'•NQT VA�I� UNTIL PROCESSBD
heroby apply for a build'mg permit and 1 acknowleclgo that tbe iztiqaxnati4�n above is oannplete axid accurate; that tha work wiU be in
�nformance with th� ordinanaes and codes of chc City of Fridley and with tho Minncsota Construotien Codes; tbat 1 underst�ttd this is not a
:rmit but only aa spplicati a perm t and work is not to start without a permit; that the work wi11 bo in accordsnce with thc sppraved
an in clto case of atl work w i u' , eva�w a�d approval of plans.
ihiAT(1RE OR APPLICANT FRMT 1JANFB �qt"�' ���� "� pATE 6ry 1� 1