P - 47778Building
xnspections
753-572-36a4
763-502-497'� FA.�
BUILI]��TG-
RESID�S'�'�'�A� APP�IC�TIO�T
CYT�Y' UF FRITIZ,�Y
'DATE �I�/ZQl 1 YOURE-MAILA�DRESS salesC�a liberrirf� com
s�rs,�n���ss 5121 Hu�hes Ave NE Fridiev M7*� 55421
THI$ APPLICAIVT 1S: O QWNEtt $]CONTRACTdR
P'errnit Na.
Received By:.�lt'�
bat��:�.� ! i �V Q�
rROPERTY OWNEW �An��: Tonv iVlaak
TENANT AAORESS: S 1�I �ughes A'V N CITY �'�j�� STATS��jzIP 554 .l
AHONE;. 763-572-8240
CpNTRACTO� NaM�: Libert�y Exteriars LLC
Si1�MIT A�OPY pF STATE LICENSE# ZO�3d�$%
YQUR STATE LICENSE L.�a1D CERT NUMBER NAT-4Q$ l 7-1
AND CERTIFICATE OF ADnR�55� 640 Marn St N ctTV Cambridge ST'ATE �1P5 00�
INSCIRANCE nun*r� 7G� cdn cnn-r � __ . _ _ _ _ __
PROPERTI�' TYpE
QF WORK:
❑ 5INGL� �AMILY/NEW CONSTRUCT(ON
❑ TWO �AMrLY/NGW CONSTRUCTIOid
Q $A$�MENT FINISH' Q CZOOF
o D�cK � SIDJNG
D NEW HdM� CONSTRCICTCON
Q MAiNTENANCE/REPAiR
s,2�
❑ ADDITIpN
❑ rteMOnE�.�Nc
❑ oRatrr rrL�
n orx��
usscr�a� wo�K as►�va noNE _Remove � Re�lace Asnhalt Shin�les
SIZE OF IMP20VEMENT LENGTH WIDTi� H£IGHT SO FT
ti00FINC C] l'-YC7USE ONLY �T
NU'MBEIt OF SQUARES 27 �1 T-10USL & QARAGE BASEM� '� $EMOIJELING SUBMIT•
�;Ap� � I . Existing Floor Pian
-----� 0 ATTACHED GARAGE 2, Proposed floor plan
PRpPQSED S3ZE: CJ 1j�TACH�D GARAGE 9, List of struecur�l members to be used
PROPOS6b NEICHT:
SIDING FpR NEW CONSTI2�JCTION INCLUDING DECKS,
���"Y� �„ISoPfiY ADDI�jCij�4 Rr PORCHES SIJBMIT�
� AIu�Minum p-�r�m 1. Site Alan/Survcy show;ng Ehe exis�ing suvctures
❑ Other _ �j Fascia and proposed projeet.
W1NDCIWS 2, Twp sets af construction plttnS
iN EX1STtNG OPENINGS OYCS �No LOCATION 4F WINC)OWS �OR'WrNDOVVS CPROVIDE l)-VALIJE AN�
OR FOR NEW OPENINGS-aESCRi��, 512� �F MANUFACTUR6 SiiCKEfi ON W1NT70W.
OPENING CHANGES &
TYNE QF WINDOW TO $E INSTALLED NUMBER OF WIND4W5
ALL �'EES A� �ASETI OlV VALUATION, INCLlJDTIYG THE CDS'I' OF LAS�R AND 1Vi(AT�Tt1ALS:
(EtSYNC TH� ��97 U.B.0 �'EE SCHEDULE)
TO'x'A� JOB VALUATION S _ OCCY1pAN'CY TYPF.
Permit Fee
Ptan Revier�v
Fire Surchargc
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Cqntrol
Park Fee
Sewer Main Charge
Tatal Due
� - • -�
$ _ � 7
�
�
$
$
$
See �ack Page for Fee Schedule
65% of $uilding permit Fee
.001 times the tocai job valuation
.0005 x Permit Valuation Minimum �5.00
$5.04 {5tate T.ieensed 12esidentisl Cantraetors)
$2230 per SAC Unit (Plarts to MWCC for deterrnin�tion)
ft�-6ft= ftx$25=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of �'ridley Attach
THIS i5 AN APPT.(CAT10N �OR A PERMIT-NpT VALlD U]J7'IL PtiOCESSED
C hereby apply fbr a building perrx�it and 1 acknawledge that thc information above is compl¢te and aacurate; that the work wili be fn
conformanee with the ordinances and cpdes of the City of Fr'rdley and with the Minnesota Construetion �odes; that I understand this is not a
permit but only an appl;cation for a permit d work is not to start without a permit on site; that the work wi!! be in accordance with tht
approved plan in the case ofalt o c which eq res review and approval ofplans.
SIGNATUREOFAFPLICANT PRlNTNAME_�',clwar�i �l1i�k1i1G(j,�j DAT������
APPROVqL INSPECTOR SIGNATUit�
PLEASENOTE: SEPAItA'r' PERMITS aeF.RF.nrrrt��nx�no or �r�,ro,,.,,- �. r,�T.,Y,-,. �.�.,�.,�,.,,.._..�.. __.__�_
Wd 9£�9£�Z6 6 LOZ/6/9 �a��d g/� :a6ed unnou�un :uaoa�