P - 48010�.� � Y vr r iuUL�: Y MU V 1N U(] DEMO [] PERMIT APPLICATION
6431 University Ave NE � -
Fridley MN 55432 ' ,
(763)572-3604 FAX (763)571-1287
�REC'D NO V 3 0 2011
Job Address : ����.���5f;1� f�, �
Legal Description:
Owner & Address: j��2 x,qpT� � ,c�U� � Tel. #,����5'/�y/
Contractor: �..��j�� ���� � � Tel. #
Address : State License # �Q� y��'"�j
"?(,� 3-- ���-� �9 S��^ CRIPTION OF BUILDING
HOUSE: Length Width Height Sq. Ft. Cu. Ft.
--°GARAGE : Length �_ Width �_ Height �! Sq . Ft . L�0$ Cu . Ft .
OTHER: Length Width Height Sq. Ft. Cu. Ft. I,
Estimated Cost $�)'� Approx. Completion Date '
CALL
Moving Route:
STATE ONE. AT 651-454-0002 FOR UTILITY LOCATIONS.
DISCONNECTS BEFORE WRECKING/MOVING STRUCTURE_
APPROVAL(S) REQUIRED PRIOR TO ISSUANCE:
�
MPCA: NOTIFICATION OF INTENT TO PERFORM A DEMOLITION O YES O NO
WATER AND SEWER DISCON�ECT PERMITS MUST BE ISSUED PRIOR TO DIIKOLITION.
ii
❑ Wate Bill a d:
❑
Bldg Offic al
❑
E . g
❑
Fire Ma al
[ ] /or Collect [ $ _ � Signature
f
Conditions
Conciitions
Conditions
PT.T•
The undersigned hereby makes application for a pernut to; wreck/move the building described above, agreeing to do all work in strict
accordance with the City Ordihances and rulings of the Building Division, and the State �ode which requires any water well on the
property to be sealed by a State licensed water well driller, and hereby declares that all facts and representations stated in this application
are true and correct.
ALL DEMOLITON DEBRIS, INCLUDING FOiJNDATION & SLAB, SHALL BE REMOVED FROM SITE
/���'1l _
Date S��na �re -
Movin�
Principle building into Fridley . . . . $300.,00
Accessory building into Fridley ...$ 42.00
Through or within the Ciry ......$ 20.00
Move a building out of City ......$ 20.00
�
, PERNIIT FEE: O
Effective O1 /O1 /2011
. Wreckin�
For each 1, 000 cubic feet or fraction. .....$1.25
For structures which would be impractical to
cube, the fee shall be based on the total cost
of wrecking at the rate of $6.00 for each $500.00
or fraction. �
MINIMUM $20.00 Office Use Only: SAC-D form completed