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AF - 47208/� n � . P.GCEIP'!' FOR CL:RTII'ICA`I':i Or 7'ITLB . ` .,�.��� , 19 75 , Received o£ Thc City of I'ridley of Aitoka County, bfinnesota, O��iier's Duplicate � �Q�b �` �� � � CertificaL•e of 1'itl.e *+�. L� � iQ�'�.tn�sses '�____ �`�L..���%�- 7d : , S't'At'L o�':1 `r�/1fN�SaTi9 � )ss. County of �/v0 /f�• ) . , � On this ��Q �� day o£_��G , '_, A.D. 19�, i�efore me, a hlota Public taithin aiid for said Co.uTity, personally appeared ig,e�3/�i�'� �T..� O�/�?ES . : to me k.iown to be the person described isi and �,•iio execute�I the foregoing ii�stru:nent ar.d acknowlcu�ed thatShe executel the samc � t`� free act an ced. y � • la� '.�� " �S ' • ' ,�""'r, CLYDE V. MOF2AVET� . :�it ► NOTARY PUi3UC — MiNNESOTA ' �+ � �,�.. ANOKl+ COUNTY ��y�� T' G~' iC ,�, .� S� � My Commission Expires Dec. 20,1580 (�.�'s'13 H��Ke�� Si��E'r . SUBJECT City of Fridley - _ 15 8 2 2 � AT THE TOP OF THE TWINS g U I L D I N G P E R M I fi ; � RfCEiPT NO. � �y ------� COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. � ,� A� ���'1 � CITY HALL FRIDLE� 55432 NUMBER FEV. DATE PAGE OF APPROVED BV i.���•J \i/ �.J . 612-571-3450 910-F15 7/11/80 � � JOB ADDRESS 6813 Hickory Street N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 2 Ostman's First Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jeffrey W. Ostrowski 6813 Hickory Street N.E. 574-1760 3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDFESS ZIP PHONE LiCENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION � ALTERATION � REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Construct a 12' x 18' Deck with.storage space underneath 9 CHANGEOFUSEFROM TO STIPULATIONS SEPERA'1'E PER�iI1T5 R�CJfR�Q �OR 11VIRfNG, w �Ei�fi1�iG, PUiM81NG A�t� SIG�. e� ��NG '�EtErNON�p �� �� utllttles ELfCiRl�. G,� ��, REQV�a�o 6� �,��,, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. , AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PAfiKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �' STALIS 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 y�`$OO �. �JO WITH WHETHER SPECIFIED HEFEIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- �`7�50 STRUCTION OR TNE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $8.00 S�GNAT E CONTR 70aoa oa¢ DAGENT IDATEi WHEN PROPERIY V DATED THIS IS YOUfi�PERMIT .� ' �i � �d SiGN U OF ERUFO BUILDERi �DATEI BIOG WS7 � pTE 0 CITY Oi' }�i;i�Li:Y � • A�'PLIC/1TI.Oid �'O{t RfSILCNTIl11_ [�UILD�"�(� {�fRP�4TTS (fdeYr, Al�:cration�, /ldditions, or IZ4pairs) d�'i���{Z: �S� �� l,/.� � � � C Fj'�I�fL✓ �/. .__.__.�_....� ADDRESS : ��/,3 /'��� lc � R'��_ _ Sl _ 1V� . T[:L N0: � -/�6 � � � BUI LOER : � ,�?;�lt � � . � - -- - _... _ I n��c�css: � ' TEL N0: ' � Construction location . s���c� No : __� I � sT�LT: �r � v � I � � � . . � I,O7! : � BLOC'iC : � ADDI T IOtd : ��S'% /�'� ,�h! S � R S T � D�1V . .. Corner Lo�: Inside. Lot: SetbacY.: Sidey�x'ds: . . Ap�licant attach to this form two Certificates of Survey of lot and ' proposed building location dracan on certificates i.o scale. DL-SCRI'r'TIOid OF COi�fS7RUCTION ~ � - ' ���� Front: ���� f Depth: �C� � Height: C� � . � Squa�e. Feet_ Glabic Feet: �� ����• �Yo .�.:. Depth: Height: Square� I'eet: w Cubic Feet: . Type of Construction : ���v Estimated Cost: $ �✓ h• - . _ . ; � ,�. ; Zb IIe �mpleted: � .�}'i� S ' Alt. A Alt. B ` . - ' k . . i Pro�osed Drive�aay Width If New Opening Is Desired: _ $ $ ; � . . . S�E REVERSE SIDE OF SHEET i . . t . . � a�e undei: signed hereby makes application for a permit for the h�ork� hex'ein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances�and ; rulings ot the lleparUnent of 13uildings, nd hereby declares that all the iacts and � repres tations stated in �his appl.ic io ar ue and coxr � ; f � DATE. � / �� SIGNATUFI, : �� • . • j i Sti�ula�io�is : � : ' � . ` , � � , � �" �� . � �,�� s � • . . . . ...r�lP� . ...Y_r��`.-,a. ' , i - . - ._ _ _ , - — --. . __ _ __ ___._._ ----._ ___ __ ,_ _ _ ._ _ __ __ - ._ _: { J , ; _ ; ' , , ; __. . . i _ _� _ _ . - . - � , , . _. . , , ,.. __ _ _ __ __ __, _ ., , : - . . � _ ,t � . _ _ .- _. __ __ . _ __ . . _. . - �-- � : . . ,, , , , : _ _ _ _�_ . ____ __ _ ._ _. _ _ ' � : 4 . • _ - : . 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