AF - 46157BUILDING PERMIT
ViLl.age of �ridley, Mi.nn. N° 2 317
Date ���,�•`•�� �' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0
Owner ���r���//�ii��*��. i . . . . . Builder . . � ,�e'-:r��±� � � . . . . . . . . . . . . . . . . . . . . . . . .
Address !'� ►I�,�' �+��'<�`'i� ' 'JR�'�'t� +� Address . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .
LOCATION OF BUILDING
No. ��:�r�,+'. ;#;.. . . . . . Street . . ����:d:-��• +L�.' ��„�. lG-�."�cC.�a . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . . . .
J r"d�
Loi . . �y�:':�.. . . .. . Block . . . .�I',.i/M!��' . Addition or Sub-Division . . ���� J��'�: . :���,�, „��e�
.��.�� �
Corner Lot ............ Inside Lot ............ Setback ............ Sideyard ..........................
DESCR[PTION OF BUILDING
To be Used as:
h «
'�`���;,�.... Front .��'... Depth .��,.... Height �,%�� ..... Sq. F't. ........ Cu. Ft. ........
r
.................... Front ........ Depth ........ Height ......... Sq. Ft. ........ Cu. Ft, ........
Type of Construction :;��,��,. . . Es� Cost .�.'�pd . . .'��. . . . . . . . . To be Completed . �.,��������
�� � �,, ll-
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In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the village of Fridley.
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d ����►'�`�''� a�'°� �'�..��,�:
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In considera�ion of the payment of a fee of $. ...� �, permit is hereby granted to � ... .. .
' ,� •��• •�.�.�:"•
t���.�a. .. to construct the building or addition as described above. This permit � granted upon
ie expre���idition that the person to whom it is granted and his agents, employees and worlunen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
�ridley, Minnesota. regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ardinances. ,. .,��
. �'�f � •f���';'. • . f �.r!-.�ii3'�?�^ Building Inspector
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspec4or for separate permits for these items.
Fth� ,' vi
., .. ,.� ,
�
City of Fridley, Minn.
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i
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�j � � TIO _ B��G
No. =��,�;L�Street � Part oP Lot
Lot � __ Block Addition or Sub-Divlsfon ..._.._
Corner Lot _ 7ns3de Lot � Setback __._ Sideyard
Sewer IIevat3an
Foundatton IIevation
DESCRIPTION OF BUILDING
` `° ° • � FSront �. Depth .��=.� Height �6�.-- Scl. F't. ���� Cu. F't�—.��=-.re
� ___ Depth ght � Sq. Ft Cu. F't.
7,'y�e oP Constructi � Fst, � � �`� To be Completed
In cansideration oE the isauance to me of a permft to construct the building described abave I agree to do
th� proposed work in accordance wlth the d�scrlptlon above set f in compliance th afl vlsions oP
ordinancea oP the dty oP F�idley. _ �
In c�afderation of the payment oP a fee oE $��— perrmft 9s hereby �ranted to
to construct the buflding or addition as d�cribed above. This �ermit fs granted upon
the eupr�s condition that the peison to whom it is grauted and his agent�, employees and worl�en, in all work
daae in, around and upon satd building, or anypa� thereof, st�all conform fn all reapects to the ordinanc� of
FridleY, BZinaesota regarding location, construct�on, altera.tion� maintenance, repair and moving of buildings
within the dty ]imits and �ith s pernait may be revoked at anY.�ht�onu �vi�n of aay of the Provisiona of said
ordinanc.ea.
Hufldiag Ins�ctor
� NOTICB:
ihb p�rmh doa not corer f6s co�leuefhm, iesta0�llee to� vr6�teg, P�m6. 6p 6�8� �ru ar water. B� wro to �
� Buildiog le�etoe hr apar� � foe t6as It�ms.
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APIsLICATIQN FOR BUILDING PERMIT
CI�Y OF FRIDLEY, NaI�SOTA
OW11�Ii ° S NAME
�o
ADDRESS /��� i�k�'�"•c''.�� ��u-[- L�DDRESS �e° �'�� '� �`-rd'� ��t.��..e�
LOCATION OF BUILDING
No. ���� Streetf��G ��.� part of Lot ��
Lot Block AddiCion or Subdivision
Corner Lot Inside Lot � Setback Side Yard
SEWER ELEVATIOIQ FOUNDATION ELEVATTON
Applicant �ttach Co Chis form Two Certificates of Surveq bi I,oC aad proposed build-
ing location drawn on these Certificates.
DESCRIPTIOIQ OF BUILDING
To be used as:
_ � Front � � Depth 2 �° Height %� /
�
Sq, Ft. Cu. Ft.
Frone Depth Height
Sq..Ft. Cu. Ft.
Type of Construction�_ ,� Estimated Cost /'��"
To be Completed_ _ �f'r� /, /��-.��
�
The undersigned hereby makes application for a pet�mit for the work herein specified,
agreeing to do a11 work in strict accordaace with the Cftq of Fridley Ordinances an�
ruliags of the Department of Buildiags, and hereby declares that all the facts an�
�representatioas atated ia tbis application are true and correct.
IDATF�� � �i % %`� SIGNATURE , e/%���.,�'
(schedule of Fee Costa can be fouad oa the Reverse Side).
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BUILD?NG PERNgT FEE S�i1LE
Section 2e The Tnspector of Buildiage sha11, before ies�ing any per�►�tt fn�
�he erecCion of aay building or atructure, or_for any addition to anq ex3et-
ing building or �t�uceure,:or for anq alteratians or repaisa to any exio�ing
building or stcructure, upoa application therefor, require the payraeat by the
appl3cant for auch g�erm�t of fees�Cb Che�amouat herein below set forth and
in tYee manner herein provided to-wit:
2.1. For aay such permit for the erectioa o,� �ng fire-proof building, other
than a garagea warehouse, faceary or grain elevator� or for the erectioa of
any fire-proof additioa; for similar occupancq, to any existing building
shall be at the rate of $1.4Q for each one thousand cubic feet, or fractian
thereof, in such cubical contents.
2.2. For any such permit for the erection of anq fire-proof garage, c�sehouse,
factory or grain elevator, or for the erectioa o€ any fire-proof additiaa,
�o� s�.milar occupaacy, to any existing buildiag shall be at the rate of $k.25
foz each one thousaad cubic feet, classified as P1firepraof" by Sectien 502 of
t�.ie M�Lnneapolie Building Gade. •
I�4US�S
2.3. For any such permit for the erection of any non-fireproof buildiag othes
than a garage, warehouse, factorq os grain elevator, or any non-fireproof
addition, for similar occupancy, to any existiag buildiag - permit $1.00 fox
each one thousand cubic feet.
GARAGES
2.�5. For eny such permit for the erection of anq non-fireproof gasage,
w`rehouae, factory or grain elevator, or for the erectian of any non-fire.nra�f
addit��s, for e3milar occup�ncy, to anq esi�ting buildiug or for each Euch �
t�ildfng or addition - ninety cents ($0.90) for each oae �housand cubic feet
or fraction thereo£, in Che cubical cantents thereof with a minim�m of $4.00,
For the purpose of compu�iag teea for building perm3ts, the cubical conteats
o€ �--l�uilcliag-=�r.°ac�ditioa - to_�--�if�zz�n--��3�gh�-thXOUghout ..by mul..tiplying the
ground area covered fram a poiat siu (6) inches below Efie fIoo� liae of thE
basemeat or cellar to the average beighe of the upper surface or to the
averege height of the roof surface of the main gable of a pitched roof.
2,5. For xepairs or alterations to an exietiag structure, the fee aha.11 be
at the rate of $3.00 per each Five Sundred Dollara ($500.00) or fraction
thereof in the cost of all propu,sed work.
2.6 . Ia no CH�90 9h&�.1 t�12 fpp chargad fnr anp p�rwt c ae set forth 3n
SeCtiaa 2 be less than $4.()0.
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STATE OF MINNESOTA
DEPARTMENT OF NUMAN SERViCBB
444 LAFAYETTE ROAD
��p�� ST. PAUL. MINNESOTA ss101
J
Date
% � �
�
Zo ng Authorit
� �� �,�-� ���,���
treet Addres
� � �� ��
City State Zip Code
�����
DHS-2722 (9-85)
PZ-02722-02
.��'a���Q/ 7�.�' i�� ` '
/�- % ��
RE: ZONING NOTIFICATION OF APPLICATION FOR LICENSURE
Subject: � �������,�������Type of License:
Name of Day,Care Home Applicant Family Day Care
�'��—' a����`���°������°/%/%f/�,�Group Family Day Care
Street Address
���� _���
Licensed Capacity �"�
City �� State Zip Code Phone No. ���% %�
a
This is to inform you that we are in receipt
licensure under Minnesota Rules, parts 9502.0300
Rule 2), Family Day Care and Group Family Day Care
this license is subject to compliance with the
Statutes� Sections 245.781 to 245.812 and 252.28�
the Public Welfare Licensing Act and the rules of
Services.
of an application for
to 9502.0445 (formerly
Standards. Issuance of
provisions of Minnesota
subdivision 2� known as
the Department of Human
You should note that under Minnesota Statutes� Section
3, a licensed day care facility serving 12 or fewer
considered a permitted single family residential use o
purposes of zoning. Subdivision 4 of the same section
licensed day care facility serving from 13 through 16
considered a permitted multi-family residential use
purposes of zoning.
If we do not hear from you within
will consider the above-mentioned
your local zoning code.
Sincerely,
� J % � �i �i
� , � , � _ �` _ �i� �.�
- - . . - :/
Street Address
245.812, Subvision
persons shall be
f property for the
indicates that a
persons shall be
of property for
30 days after receipt of this letter, we
day care home to be in compliance with
COMMUNITY HEALT1i & SOC'IA{.
8ERVlCES R�E°ARTMENT
C01fNTY OR ANOKA
CpIJRTF101iB& FOURTM RLOOR
�wcw, �tNNE+BOTA sasos
Name of Agency Organization
City State Zip Code
LY°(.s;Ir'/ �,{�^,� �J G Ls�'(,d(O� v .� ����
�i�4`% E�
AN EQUAL OPPORTUNITY EMPLOYER
SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i�
� �
� • COMMUNITY DEVELOPMENT DIV.
� ; V ������,
r � � PROTECTIVE INSPECTION SEC
� � �
i--_-� �"' �,� CITY HALL FRIDLE� 55432 NUMBEfi aEv
i 612-571-3450 910-F15
108 ADDRESS 1344 Hillcrest Drive NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION
oescR. 17 3 Moore Lake Hills
2 PROPERTY OWNER MAIL ADORESS
Earl Hansmann 1344 Hillcrest Drive NE
3 CONTRACTOR MAILADDRESS
Thurs Roofing 5717 113 Ave N, Champlin MN 55316
4 ARCHITECT OR DESIGN�R MAIL ADDRESS
5 ENGINEER MAIL ADDRESS
6 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW
8 DESCRIBE WOHK
Repair flashing in
9 CHANGE OF USE FHOM
STIPULATIONS
❑ ADDITION ❑ ALTERATION
TO
TYPE OF CO
SEPARATE PERMITS ARE REQUIRED FOH ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG.
I HEREBV CERTIFV TNAT I HAVE READ ANO EXAMINED THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WOFK WILL BE COMPLIED $3OO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMiT FEE
PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGULATING CON- $21.00
STRUCTION OR THE PERFORMANCE OF CONSTFUCTION.
� PLAN CHEC
���-��-��! �,�,�� �j�_ Licens
�' SKiNATURE OF CON � RACTOR OR AUTM0�71ZED AGENT IOAT6 �u
SiGNATURE OF OWNER �iF OWNER BUILDERi IDATEI
DATE I PAGE OF
4/14/97 / �
�.�4��1
��
RECEIPT NO.
Y� �
APPROVED B�
SEE ATTACHED
SHEET
571-1839
ZIP PHONE UCENSE NO
424-5624 9346
ZIP PHONE LICENSE NO.
ZIP
� REPAIR
E�
S0.
STA�LS
PHONE LICENSE NO.
❑ MOVE ❑ REMOVE
1
OCCUPANCVLOAD
CU.FT
EET PARKING
IGARAGES
$.50
C CHARGE
Fire SC $.30
iTAL FEE
$26.80
THIS IS Y R PE9M
NEW [ ] Effecrive 1 / 1 /97
ADDN [ ] CITY OF FRIDLEY
ALTER [] SINGLE FAMII,Y AND DUPLEXES R 1� AND R-2
BUILDING PERNIIT APPLICATION �j�
� �
ConstructionAddress: �� �'�� � � � C, �^�.S 7�
Lega1 Description:
Owner Name & Address: �� r I : q�, 5 y� �� v� � � ' Tel. #�� � 1 g� �
Contractor: %1 � �� i.. 1VIN LTCEN5E # 7`� ��
Address: .S� 7/�—i I 3'� v c. /v >� Tel. # y� y s� a�/
LIVING AREA:
GARAGE AREA:
DECB AREA:
OTI�R:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
�II�
Length
Length
DESCRIPTION OF INIPROVEMENT
Width Height
Width Height
Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
po
consa�uction Type: %�{�� ��' v� 1/e_y s Estimar�a cost: $ 3(7� —
� (Fee Schedule on Back)
Driveway Curb Cut�Width �Ne.eded: Ft. +.6 Ft = Ft x$ _$ � �
DATE: . =1 �i � �'_% APPLICANT: j�-L.e�:c-�-- � Tel. # �� �f S`C�� �L
Permit Fee
Fire S�rcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
� � �. ��
$ . � (�
$ � ��.
$
$ �� (�Cs
$
$
$
$ �
� ��-�
CITY USE ONLY
Fee Schedule on Reverse Side
.�1 of Permit Valuation (1/lOth%)
$.50/$1,0� Valuation
$950 per SAC Unit
$5.00 (State Licensed Residential Co�ractors)
Alt. "A" or Alt. "B" Above
�450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement 1Vecessary [] Not Neeess�ry j].
s�
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing �rmits for the erection of any building or structure, or for
any addition to any existing building or structute,� or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
, TOTAL VALUE 9�, : FEF.S � ,. . .
$1 to $5� -
$501 to $2,OU0
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $SU0,000
$500,001 to $1;000,000
$1,000,001 and up
$21 (Minimum Fee is $21 �plus surcharge) -
$21 for first $500 plus $2.75 for each additional $1� or
fraction thereof, to and including $2,�
$62.25 for first $2,Q00 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,(�?0
or fraction thereof, to and including $50,000
$574.75 for first $SQ,�O plus $6.25 for each additioffi1 .
$1,(?00 or fraction thereof, to and including $1QO;i�O
$887.25;for fust $100,000 plus $5.00 foi:.each additioml
$1,� or. fraction thereof,_to and including.$5�,�
$2887.25 for the firsf $500,000 plus $4.?S for each additional
- � . _. . $1,000 or fiaction.thereof," to and inclu "�'k , � . . :
..
� �1����
' �.
. . .� .... ,. . .., -. f ., _ _
+
-- --... .... � __... .. �.. _.w�.�_..... .... �. � . ..
$5012.25 for the first $1,(�0,�0 plus $2:75 for each_ additional
$1,0� or fra.ction thereof
DRIVEWAY. DEPRESSION ESCROW =`
(Concrete G�.irb Streets Only)
��, ,
Alternate "A" : Removal and replacement of curb and gutter only - Driveway� width plus 6 feet times $13.50.
Alternate "B": Removal and replacement of curb and gutter and install�a 3 foot wide
approach with 6 inch depth - Driveway , width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site. �
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
wi(1 be required before proceeding with the framing.
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C�IIlVINEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1: Has been carefully examined Yes () No ()
2.
�
Is free from rust or deterioration
Has no foreign objects lodged withiu
4. Is securely supported
5. Meets all current Code requirements for size
and total BTU's connected
6 Has total heating BTU's of
7
�
All other BTU's
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes()No()
TOTAL BTU's
Has a liner been provided for water heater Yes () No ()
Has combustion air been provided for water heater Yes () No ()
Remarks: �
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
�
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
57Z-36U4 l+'AX:
: 1344 HII.,LCREST DR NE
: 243024120038
: MOORE LAKE HII,LS
: LOT 17 BLOCK 3
: ELECTRICAL
: RESIDENTIAL
: ADDITION/ALT'ERATION
571-1287
PERMIT NO.: 2004-01464
DATE IS5UED: 09/Ol/2004
VALUATION .
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL SAVERS SWITCH.
# INSPECTIONS 1
APPLICANT
HUNT ELECTRIC CORPORATION
2300 TERRITORIAL RD
ST PAUL, MN 55114-
OWNER
ZAPPE THOMAS A& LINDA O
1344 HILLCREST DR 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 know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl�
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 PERMIT FEE - MIN (RESn
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 117431
�r,r[�lc[� i� r�tuvu 1 � 1c�� u uc�L r Ux w utclt u 1 t1�x t t1A1v U��l;Ktti�ll AtiU v�.
20.00
0.50
20.50
Building
IIlS�7eCti1011S
763-572-3604
763-502-4977 FAX
DATE ' I �'% '" I �
srrE avnxESS 3 �
THIS APPLICANTIS: � OWNER
PROPERTY O�VNER/ N�:
TENANT - ----
CONTRACTOR
SUBNIIT A COPY OF
YOUR STATE LICENSE
PROPERTY TYPE
PIItMIT TYPE
TYPE OF �VORK:
DESCRIBE �VORK Bffi+TG Ib
ROOFIPTG
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED F�IGHT:
SIDING
O Vinyl
O Alnmimim
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
�czzvE i-i-os
YOURE-MAII. ADDRESS
��
�
Permit No.: �r�'� 1
Received By: V�`�3
u�:,��� � � �� _ � A�.
`v � •+ 'L17i�./ �'�1;J.'1+►'L+.71L/ ` �� �" « �iI'lr��'f� L/ .� r _ '
• � _ �
�'�� I •'
O SINGLE FAMILY/NEW CONSTRUCfION SIZE
❑ TWO FAMII,Y/NEW CONSTRUGTION STORIES
O ADDITION O GARAGF/SF�D
� BASIIvffiVT FINfSH 0 ROOF
O DECK �'$IDING
� SWIIvA�1G POOL
�❑�1 W HOME CONSTRUCITON ❑ ADDIITON
�"MAINTENANCE/IZEPAIIZ O REMODELING
�� ���_ _�� r-ss �
LENGTfi WIDTH
— O�IOUSE ONLY
� HOUSE & GARAGE
ATTACfB?D GARAGE
DETAQ�D GARAGE
�S��L
WIPDJOWS
IN EXLSTIIVG OPENINGS OY� ONo
ORFOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WIIQDOW TO BE INSTALLED
ALL FEES ARE BA3ED ON
COTAL JOB VALI
Permit Fee
Plan Review
Fire Surch�rge
Surcharge
License Surchazge
SAC Charge
Curb Cut Eserow
Erosion Co�rol
Park Fee
Sewer Main Charge
O WIl�IDOWS
❑ DRAIN TiLE
f] OTFIER
•�� �: 11
BASEMENT REMODEIdNG SUBMIT:
1. Exietmg Floor Plan
2. Propoaed floor plan
3. List of etractm�al memba�e to ba used
FOR AIEW CONSTRUCITOAT INCLUDING DECKS,
��� ADDIITONS. & PORCf�S SLTBMIT:
O Trim 1. Srte Plao/3mvey showmg the existmg etradures
❑ Feacia a°d pr°posed pro�ect
2. 1'wo eata of coLStrudioa plans
3. En�gy Calculationa
LOCATION OF WINDOWS
N[JMBER OF WINDOWS
�ALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
��SING TfiE 1997 UBC FEE SCHEDULE)
$
$
$
$
$
$
$
$
$
$ �/�'7S�
See Back Page for Fee Schedttle
65% of Building Permit Fee
.001 times the totsl job valuation
.OQOS x Permit Valuation Muwimum $.50
$5.00 (State Licensed Residential Contractors)
$1825 per SAC Unit (Plans to M4VCC for determination}
ft+5ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks uavable to: Citv ofFrldlev A1tac
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I heiebY aPP1Y for a bnilding geamrt and I aclmowledge that the information above is comple[e and accnrate; fhat ihe work will be in confo�ance w�h ihe ordinance.s avd code,e
of the City of Fridley and with ihe Mmnesota Conehuction Codes; that I uade�stand thie is �t a pamit but only an application for a peamrt and work is �t to start withwt a
p�it on s�e; that tha wodc will ba in accor w' a a ov lan ' the of all work wLich reqmres review and appraval of plavs.
SIGNATIJRE OF APPLICANT PRINT NAME ���F�J �IJ .�jj��s�-7� DATE����'"
APPROVID BY DATE
PLEASE NOTE: SEPARATE PIItMITS t1RE REQIIIItID FOR PLUMBING, II,ECTRiCAL AND MECHANICAL WORK