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P - 35807Building Inspections 763-572-3604 763-502-4977 FAX ______ DATE � 0�7 .I1I S1TE ADDRESS S�i /.� THIS APPLECANT IS- PROPERTY OWNER/ TENANT CONTRACfOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERT[FtCATE OF IAISURANCE PROPERTY TYPE PERMIT TYPE BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY Permit No.:�� �� Received By: � YOUR E-MAIL ADDRESS O 4WNER �OIVTRACTOR ADDRESS:�� � I-��•�%� l�t1t CITY PHONE:?��-S7 J�S STATE LtC£NSE �' OI � I o�9 �-i O� _ LEAD CERT NUMBER non�ss:, j�? s�o 5a �w�.se � � E. , crn l� e�r�E �1(s"� d�14 � 7� 9 �nx �(� 3 �INGLE FAMILYlNEW CONSTRUCTiON SIZE ❑ TWO FAM[LYiNEW CONSTRiICT[ON STORIES�_ � ADDTftON CI GARAGFJSHED LI WINDQWS ❑ gpSEMENT F[N[SH J�.1tQOF � DR!►IN T[LE ❑ DECK � S[DING 0 4THER TYPE OF WORK: � NEW HOME CONSIRUC7'10N � A�W7'!ON &(ju[A[NTENANCEJREPAIR ❑ REMODEL[NG DESCRiBE WORK BEING DONE: C � I�1,.C�A.� SIZE OF }MPROVEMENT LE]VG7'FI WlDTH �HOUSE ONLY � F SQUARES � HOUSE 8c GARAGE � �oPOSEa su�: PROPOSED HElGHT: SIDRYG O Vinyl ❑ Alwninum � ONkr p pTTACHED GARAGE p DETACHED GARAGE pSoffit p Trim ❑ Fascia IN�G OPINtNGS OYes C7No LOCATION OF WINDOWS OR FOR NEW OPENING3-DESCRIBE StZE OF OPENING CHAT►GES 8c _.......,... ..,,. ALL FEES AR� BASED 'OTAL dOB YALUATION Pecmit Fee Plan Review Fire Strcd�arge Surcharge License S�acharge SAC Charge Curb Cnt Fscrow Erosion Co�rol Park Fee Scwer Main Chatge Total Due qT6�ZiP����a ATE,�IP `� i �i►c.EMENT I�FMOI)EL�1NC,�SUBMtT' t . Eacisting Fbor Plmi 2. Pmpo� floa pian 3. L.ist of sa�ucdual �nbas �o b�n�ed FOR NEW COAISTRUCTION INCLUDIt�iG DECKS, ADDf170NS � POR�'NFS s-��!�T' 1 _ Si6e PIeNSun^oY $tawi"S � �S � a� V�P� P�I� 2_ Twn sds of� P� 3. Errcxgy Cslwl�io� FOR WINDOWS - PROV(DE U-VA1-t1E AND MANUFACTURE ST[CKER ON WINDOW. VALUATIOIY, INCLUDING THE CUST OF LABOR AND MA (USING THE 1997 U.B.0 FEE SCH�C PANCY �' $ ,�, Sae Back Page for Fee Sche�iule s 65% of Building Permit Fee $ o -OOi times the total job valuation $ 01 .0005 x Permit Valuation Minimum 55.00 $ �U $5.00 (State Licensed Residential C�tractors) s 52230 per SAC Unit (Plans to MWCC for determit�ation) a ft+6ft= ftx$25= $ s $450 Conservation Plan Review a Fce pctcrmin� try Engineering $ Agreement naxssary ( ) Non Necessary ( ) � .�- Make checks_paYsble to: CitY of FridleY Attai - THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UN'[1L PROCESSED I h�eby apply for a building peimit and I admowiedge that the inforneation above is complete and a�a►rabe: t� d� �* �II be in canformance with the ordinances and codes of the City of Fridley and with the Minnes�a Constructia� Codes; thai I understand ti�is is not a pemiit but only an applic�tion for a permit and work is not to start without a p�mit on site; tha� the work will be in �ccordactce with the approved plan in the case of all w u�res review and approval of plans. ,/ SIGNATURE OF APPL[CANl',�,,,,, •.. ,• PRINT NAME_�/`Y�r�dO�''� DATE %�% TE PERMITS ARE REQ_iJIRED FOR PLUMBING, ELECTRICAL AND MECHAMCAL WORK