P - 48206B uilding
Inspections
763-572-3604
SITE ADDRESS _
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERNIIT TYPE
TYPE OF �PORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
. YFOUR E-MAIL ADDRESS
� � �
❑ OWNER
�-�.�, ,
ADDRFSS: S�- I �_ _s =..3J ni •�-- CITY.
�
PHONE: � I a—_� J G �
STATE LICENSE # .� Li �
ADDRESS: � ��
PHOIVE � � ��✓ `�
FNGLE FAM[LY/NEW CO;
n �rwo F,vvn�.YmrEw corrs•
❑ ADDITION
❑ BASEMENT FINISH
❑ DECK
❑ NEW
�❑
DESCRIBE WORK BEING I
SIZE OF IMPROVEMENT,
RQOFING
NUMBER OF SQUARES
GARAGES
PROPOSEB SIZE:
PROP05ED HEIGHT:
Pernut
Received By:��%`��
D��C'�� � � Z 01��
AT� r v�IP�
�,_ EXP DATE
.. L�.�K.-� CiT'Y STATF.�IP
F�c_.�7�3-7��--�C� i�i
❑ GARAGESHED
❑ ROOF
❑ SIDING
❑ SWIMH�IING POOL
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DEI'ACHEll GARAGE
� DRAIN TILE
❑ OTHER
BASEMF.AIT REMODELING SUBMtt':
I. Existing Floor Plan
2. Proposed floor plan
3. L3st of structural members to be used
Ft.
SIDING FOR NEW CONSTRUCI'ION INCLUDING DECKS,
❑ Vinyl OSo�t ADDITIONS. & PORCHES SUBMIT:
� Aluminum - ❑ Trim 1. Site Plan/Survey showing the exis6ng structures
❑ Other ❑ Fascia and pmposed projecG
WINDOwS 2. Two sets of construction plans
IN F.XISTING OPEMNG3 OYes ONo LOCATION OF WINDOWS 3. Fnergy Caicularions
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES Rc '� j � -
TYPE OF WINDOW TO BE INSTALLEI? � NUMBER OF WINDOWS_
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$
$ �;
$ .aai.?
$
$
$
$
$ `� D �� l Gi
See Back Page for Fee Schedule
65% of Building Pernut Fee
.001 times the totat job valuation
.OQQS x Permit Valuation Minimum $.SO
$5.00 (State Licensed Residen6al Contractors)
$1675 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$45Q Conservarion Plan Review
Fee Determined by Engineering
Ageement necessary ( ) Non Necessary ( )
Make checks navable to: Citv of �idlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a buiiding pernut and I acknowledge that the informa6on above is complete and accurate; that the work will be in
corYformance with the ordinances and codes of the City f Fridley and with the Minnesota Construc6on Codes; that I understand this is not a
permit but only an appiication a 't and wo t at to start without a permit; that the work will be in accordance with the approved
plan in the case of all wor u v' approval plans. ��� i-)/
SIGIVATURE OF APPLIC ,�,� RiNT NAME ��
�'%'�ATE � �