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P - 48447
Building Inspections 763-572-3604 7b3-�02-4977 FAX llATE � - � ' � SiT£ Aa€3liES5 �J � �'i�iS � Pi'Lli�.��7 !S: r � e � � , , � r . � � ' � Y Ol�lt L3f�.:*:ER �'`C)ti'.':�;�`.fJ:: PROPERTY 04�VNER/ � �,i;��,��. � AY1G�__Y�Q►%l�_�! T'EI�A�iT � 1�QLlR�,�:__ L3b 1?C�1 l � -- �- r����: 1�3 � 5'f 1 • °1 `fi'g �-- ca!��€-�cTC�� s��s����►- r� c~oP� oF YOUR STATE i,ICE�SE ��.n r.����r���c�e�� ��� I'�SIJRA�3CE i'ROPERTY TYPE PERMI� TYPE TYPE OF i�V�RI�. ci�-i si��r i.�cE�;ss-;< (. l.�an`c��Kr:vc:��s�K ?tI3DF+:ESS:�S'$ Z�J`�!�!�l _���__ �.�.�,�.�L PHO�� lo� l��3'v •$� C�_ F�� l05� , lo �Si�.t�[ F.: i.�4SfL1":i'v";I 44 C't�?Vlltittil°t1()"� SiZE—�.,—�-�..��iry Ti�OFA?V131_�,tiE4� CC?'4SFRLCi9C?,'^� STC)RIES---j-- C� ri�t31'f Tt)?a El ti:�R.'-4ti�:�S6#£1� � ti�'r:?it�)!ti 5 C] B�SElb4E2aT FI:v1.SH � RtX� � I)R.�4�3v'; ���' ❑ L)ECK ❑ StU1�9G �OTHFR C7 Ski`d:�i'aiI?�G PiX?i ,S� L7 `.ti�1� liOhiE CC}?�STFti;t_Tft3\ i3 Ai3i3tTi€7ti ;��,9 �9��F�'.#4CE%R�P�ii2 L� R�l��pL2t � �'�.fa ����,C DFSCR►BE WORK f3�IT€G f}t )?�+E SIL£ C)F ShiP'ROtiE4i£"vT u�o���L NUMBER OF SQU�1ItE5 � � � GAtLAGES PROf'OSED SIZE= PROPOSED I lE1GHT: �;ill��i{' 0 vinti� � �l�€mitt3tm j� ❑ ()iher (�iA�/' � �1R� Vi�M V �i'i'.\�t3�i'�; �W, � Iiv EXISTI�lC"i OPE'�«1'vGS�Yea ❑`va (3R f iiR ti�ik` far cha,vtiS-[}t.�� iii'r�i: :�ii"t. ia'r l)PENI�iG C1Lr'�:'�GFS & ^�� �� i'F �;� �°I*��js� �9 c} i�� i�S ; :il.�..EG?_t19� ALL FEES ARE BASED OE�i VA TUTAL �OB YAL.[3ATlt7N Permit Fee t tan Review Fire Sur�harge Surcharge Licens�; Sitr�:�ar�e � SAC Charge �Curb Cut Escrow �co�ion Contm! Park Fee Sewer �iain � �ar�e Totat Due LF�4GTt! � }i'iU:�i: i�itii r �.F�Ol4'Sf: & CiA1L�GE L3 :�'TT�kC'�EE[i (i.�K.�(ii: � [H�T,4CHED GG�Kr�Ci£ _,/ ��1'371i��°� �G '��ll I R��i�ed 8v: ��?t� �e�'d: `i s�c��re�z�P 'r�-�_ o�•t � 5__6�2- ��� R�,�,_���'�A,,., D� Q�� �"3i7"i Ei � i� �tyt i f St7 FT B.'�SE��`+v'T RE"vfODELI+v'C� SL`[3�1!!T- �.. f?;icting €1ot�r Pla!n y. PrvpUS�e�3 tieacar gisn 3_ Lis( af stmctural mc.�rt�bers to be ased i � i=QR �E1V C�'vSTRi,4�71{?*� 3�Cd.UBi3�iG DECKS, � ��ax �,MHG� /�� A� arvl� '' :�.������s.� ��c:���ss���urr: �i vG� �•.. i. Site Plan Souxew shc�Hin� lhe existing swctures � �;�,` and Prapoaed Pro"Ject �F �3su s� � T��o �L�; of�:ondavclion plaa�s %. �as�r�s L°a3cecRai�cires LC�'.�'I t+�� OF �l'1^vD(?1�4 S � FnR 41'IPv'DnW'S — PROV7DE F➢-VALUE AND _ �'ia�Mtl+. TZae , ��a��s�;�c�t-�-�� s�-�z:�:rxc�� r�°f�now- l.� �NIl °�'� �#�f.R iSt � �'.z�td44`5 � % — ,LUA (+D�I, I�ICLUDIlYG THE COST OF LABOR AND MATERIALS: StNG TN� �7 U.B.0 FE� �HEDULE) �� �' •� ' � �°�'�� �CC(.iPAN�Y TYPE s—1, a See Back Pa�e for Fee Schedule � - — 6��io ot Building i�ern�it �"ee ��S'; o � .Q01 tisn� the total jc�b vaivation � � �—� .Ut�U� a i'ermit Vaivation Minimum �S_� � c^ � � �1.� �S�e Li:,�:s�s� R�,�sid€rstia9 �'a�tia,ctars� � �2230 per SAC Unit (Plans to MV►�CC �or deteranination) � ft+6it= ftx��5=� � $���i C��+�a�ti�� �'!an I�evie� '� Fee Determine� b�r Engine.enng � A�,�re�.--�mment neeessar�� � � ition ��c�ssary i ) ��� �_ � ��ke checks paygbie to: Cih' of Fridley Attach Tx�s is .�� <�QQ[_�c,��r�c��w �c7� .3 r�t_��v��r-��� r ti�_�� r� �,�r�� Q�a��ss�r_[� I lteseby aPP9y �'ar a buiiding permit ar� 1 ac�nawi�dge that the informativn at�ii�e is con�plete and accurate; tha� ti�e w�rk wii] be in conformance with the ordinances and cod� of ch� Cit� af Fridlev and �evi#h the iV(innesota Construction Codesr that t understand this is not a permit but only an application for a p�rmii and tivork is not to s[arC �vithout a pem�it or► site; that tt�e work witl b� in accordance with the a�pro�£ed �lan in 3he �se c�' 1� rk ��hs�#: s� ises i=ie�a� a��s�t��ad c�f�aa�s. � ���f� � SIGI�IA'[�I�R�OFAPPLICr1�i � lit� P"v"7����AE pVlYl ''-^'^��l D�TE '� .��'}'R��°v":�L 1?`aS?�EC'3f3R Si�: 3€:"ii� -- �-- P[.EASE TIQTE_ �EPAR _ D F(3R PLUMBING, ELEC`I"RiCAL AND L WORK i,[ 1 S � O j,� N. � � � � � � � � 1 � � O � � � � --I � _ --f � _ . .. _. .. _ —.._-_ __ — _— _.. __ — i._. _.. __ .__ "_ —_ __ _— _ . ._ —.#s_Sg. 6 P 0 Q { j ) i>... .. . . _. __ , _ ,,. __ .J e �„n... . , ..... .:_ . , .,, . ._ �4 .._.. i3 E 1� S� N O _ O � _____w____� � �._ --�._.. ___-_ --°- ________ �_.� �-- -- -�} yz..�z.,. ; _ � ��_ _ B� !� � ! �P � -P w ._ _ _ ,:� __.....-- - __ _ __ � _ � "t i ;i; E t: �} � � �� ; �n ;�.�� ...�._._.___�.____�__._......�.r._ _ . .. 4 �.. . . . _ . _--_ . -__- ��� . ..;:.:.3. : . . . _... ... _-----I . -��r t� � rn m m ° o m � � � -II � 3 � � _ � w w � m m � �. �_ - _ : , : � m c�o ro � � � N =o �____ �;, _... 3 � 3 � 3 � ° � __ m� m w m �' Q°- _ _ �' �_, _ a' a Q Q Q o°, 3 6 �` � - w m o e y a ��� 3 � -a o � _ � -- r n � o s�s c4 0� o � r. 's � � � � � a m � o � � � � � -- - � m ¢ � ° Q �' w � o � � � � � � =— - 3 a � f � ,> --- - -- . ?F= _ - - �� : � .. � , . '.. . . .. . . �` .. . .. .. _... .. . .. _._. .. _ _....