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P - 35234�Building BUILDING PermitNo.: LC��'�) ' ?�(�� Inspections RESIDENTIAL APPLICATION Received By: �1,' �'�� �63-s�2-3604 CITY OF FRIDLEY 763-502-4977 FAX ���eC°��I�� � �1n1'� rrr�:c�rivi; i-i-zoi i DATG /--� �% � � 6/ YOUIZ GMAIL ADDRI?SS /.�hL�r'�rh `L' l`"3``/� L°� Ur� sn e A��nKESS �U y� 1 %�h:KvRw �C. /v �" �P.iOZEy /Yl� �s"t/3x � I�HIS APPLICANT IS- ❑ OWN[�R �ONTRACTOR PROPE,RTY' OWNER/ NAMG S%�Z /'Tl'� L/"�N� �� TENANT ADDRF,SS: ��J l IC��'!� PL- �� CI"CY ��/,OCr�/ STA� E��IIP �SZ � 2— PHONE: � —S�'%I `j i� &°� CONTRACTOR NAMG:�J I�TiCYd L�i%Jt` CG�✓IT2uc rr�' / SURMfI� A COPY O�' STATG LICGNSE#;�0�1� � LEAD CER7� NIIMftER �3��5 �/ � d� Q� Yourzs�nrr�:►.ic��:NSr , `�r� /���� ���/ � ,4ND CIiRI IFICAI E OF ADURF.SS: �%(� PE�� A� SU`�+L% ��l,TC I75�� CI'I'Y ,[_XGCy'?�inJjr%Lr%✓STATh/� "l.IP��''3% iNS��►znNCe PHON� 9.s�- v� �-i7 Fnx %1-��/-v�2t PROPERTY TYPE �irvc;i.r rAnnil.Y/rvrw coNSTauc� ioN s�zE O "iW0 FAMII.Y/NEW CONSTRUCIION STORIES PERMIT TYPE � ����T��N ❑ cnrznGi:isur:[� ❑ wiN�ows ❑ BASEMENT FINISII �ROOF ❑ DRAIN'I'ILI: ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW I IOMI�; CONSTRUCTION ❑ nDDIlION ❑ MnIN'I�L�:NANC1�:/R1=,PAIR � R[�:MOD[:LING D6SG21I3G WORiti E3L:ING DONE: ��� �iy'-= (j� S//•�GL�,—'3 �- f�C��`�QGE' SI"LEOI� IMPROVI:MCNT LENGTH WID�I�H IiL�:IGI�'T SQFT ROOFING ❑ FIOUSE ONI.Y HqSI,MCiN'I REMODELWG SU[3M1'I` NUMBER OP SQUARE� ❑ I IOUSF c� GARAGI-: I. Fsistine Floor Plan G:V2;�GF:S ❑ A'I"fACI IED GARAGIi 2. Nroposed Iloor plan PROPOSI?D SIZE: ❑ DETACFfED GARAGEi 3. Lis[ of structural members to be uscd PRONOStiD HF:IGtIT SIUWC FOIZ NI{W CONSTRUCTION WCLUDING DF.CKS, ❑ Vinyl ❑Soffit ADDI"fIONS. & PORCHFS SUBMI'f:_ ❑ Aluminwr� ❑ Trim L Site I lan/Survey showing the esisting structures ❑ Other ❑ Fascia and proposed project. 2. I'wo sets of construction plans W'INDOWS 3. f?ner�y Calculations IN GXIS'T'ING OPENINGS ❑Yes �No LOCA'TION O� WINDOWS FOR WINDOWS — PROVIDE U-VALUF. AND OR POR NLW OPF.NINGS-DESCRIBG SIZG OP MANUFACTURG STICKER ON WINDOW. OPF.NING CI IANG�S K TYPE OF WINUOW'I�O BE INS"TALLED NUME3ER01� WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDINC THE COST OF LABOR AND MATERIALS: (�ISING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $`�,SL� OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due �$ �:i „% '� See Back Page for Fee Schedule $ 65%of Building Permit Fee $ `�1 �� .001 times the total job valuation $ ��� .0005 x Permit Valuation Minimum $5.00 $ �,�;� $5.00 (State Licensed Residential Coi�tractors) $ $2230 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$25=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ � _.� Agreement necessary ( ) Non Necessary ( ) $ ����-� '� :i Make checks navable to: Citv of Fridlev Attach Stiaulations "f111S IS AN APPLICA'CION POR A PL?RMI'T-NOT VAI.ID UNTIL PROCL�.SSIi.D I hereby apply for a building pennit and I acknowledge that the information above is co�nplete 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 1 understand this is not a permit but only an appli io for a peri�iit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the c e of Il w• hich requires review and approval of pla�.,, �j_, „ �,, � ? �.�% SIGNATURIiOP,�PPLI NT PRIN'I NAMI ����`(' .�y t` DAiE �.T�.�t��! APPROVAI. INSPECi�OJ� SIGN E �� � PLEASE NO ,; PARATE PERM(TS AR.E REQUIRED FOR PLUMB(;VG, ELECTRICAL AND MECHANICAL WORK