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AF - 46889n � �� �" Ci.ty of Fridley, inn BUILDING PERMIT ��; Feb . 19. 1969 p�r: A. L. Williams �� Same � 947 86th Ave. N. E. Ad� Same ��Y��� N° 10101 LOCATION OF BUILDING No. 5 28 Street Ironton St . 1V . E. p� oE Lot � 53 & 54 _ Bl� G Addition or Sub-Divi�tan __._Riverview Heights Coraer Lot — 7naide Lot _._. X Setback 35 � Sq�y,�d 10 � Sewer IIevation � 845 .96 848.96 Top of Footings DESCRIPTION OF BUILDING To be Used as: Dwelling �t 26' Depth 38 � Height 20' �. � �� Front Depth fTeight Sq. Ft Cu. F't. Type of Consiruction Frame ��_$14, 000. 00 To be Completed Sewer Location (Lot 52)- 123' East of Manhole WATER LOCATION ( Lot 53� -� 10' East of Sewer Check elevations carefully before construction. In consideration of the issuance to me of a permit to construct the building described above Y agree to do th� P�P�d work in accardance with the description above set forth and in compliance with e�l Pra�lsions of or8inaa� of the citq of Fridley. __.��/ "�� , � � $100.00 Sewer Connection Char�e In consideration of the payment of a fee oP $ 30. 00 ��t � g��y �� � A. L. Williams , to construct the bnflding or addition as described above. This �rmit is grant�ed u�n the express conditfon that the peraon to whom it is granted and hia agente, employees and worlanen, fn all work daae fn, around and ugon said building, or any part thereof, shall conform in all respects to the ordinancee of FridleY. M3nnesota regarding lacat3on, construction, alteration, maintenance, repair and moving oP buildinge within the dty lim�its and this permit may be revoked at a�y tjme upon violation of any of the provisiona of safd ordinaacea Official Henry F. Muhich 8�� � NOTIC� 1'his permit doei eof eever ths eonslrocHoe, instaO�Hon fee WUine, phr�bfeg, ea heaHoB, tew�r or waMr. 8� sun fo � tha Bnitding Inspseto� hr ieparm parmh� Po� �6as It�m�, �.� — � APPLICATION FOR BIIIIu�ING PERMIT CITY OF FHIDLEiC, MINNFSOTA OYNSi'S NAME �� � � _ � �; a. � � � /� , : � �. �. '� � � LOCATION OF BIIII�UING N0. � STHEQI' � f%�`d a!l %�lJ 41� �� �-���� -� ,�[�.BI+�K ADDITION 08 SIIHDIQIS ION/�1 !/ �-�"iP 1/ � L Gl 1}�/�T,.1' COR"gi LOT INSIDE LOT � SETAA!`��SIDEYgRD�_ . �_ 3Ef�lII� ELEVATION TOP OF FOCTING gpplicsesit attach to this for� Two �srtificates of SurvQy of Lot and propoeed buildiag location drs,wn or� th�ea Ce�tifice.tese DFSCR.IFTION OF BIIILDING To Be IIsed Aee /� � Front ,� � Depth � � Height � Square feet_ ' ,d' � Cubic Feet � '�/ � (� d Front Depth Height S9nare feet Cubic Feet Type of Coastruction ���� Eetima.ted Coet /� Q�' d To Be Completed The undersigned hereby makes application for a permit for the work herein epecified, agreeing to do all work in etrict accordance with the City of Fridley Ordinancee and rulinga of the Department of Buildings, and hereby d.eclares that all the facts and i�:�,r�eentations etat�d in thie application are true and correcta DATE_� /� ��� SiGrTATORE Lr7' �%/A������ , _`¢1�S�hedule of Fee Coets aan be fourid on the Reverse Sideo) � � �� � � � � � _ S� ���Q - / , / . � � - `��,�� � ��� � , � � :� n � �� .�_.� _ � �-� - BIIILDING PE'RMIT k'EE SC�UI,� SECTION 2o The Inspecto�e of Buildinge ahall, before iasuirig pernita for the erection of any building or atructure, or for �.ny addition to any exieting structure or building9 or for any alteration or repe,ire to auy eaieting buildiug� or structure, upon application therefore, require the payment by the applicant for such permit of fees �o the amount herein below aet forth and in the ma.nner herein provided to-wit: IIniform Buildi_n� Codes Type 1y 2, & 4-�1,75 for each one thousand cubia feet, or fraction thereof, in such c�bical anntente. Type 3& 5- ;1050 fo� each one thoueand cubia fee'te For the purpose of computing feee for building permite, the cubical aontente of any building or addition to a uniform height throughout by multiplying the ground area covered from a point aix (6) inches below the �'loor line of the ba.sement or the cellar to the average height of the upper eurface or to the avera.ge hei�ht of the rooi surface of the maixl gable of a pitched roof . k'or re�a,irs or alteration.s to an existix� structure, the fee ehall be at the rate of $3.00 per each iive hundred dollars (=500.00) or fraction thereof in the coet of all proposed worko In no case shall the fee chaxged for any permit ae eet forth in Section 2 be le�a than $5000� NS�SD Connection Char$es based on loeation - Area 1 or 2. �'�1 /"'� . �. -.�.--•� ' ��-.:'' CERTIF�GATE OF' SURVEY J/AMES L. KURTH , LAND SURVEYOR 4207 N.E. STN S'T'REET COLUMBIA HEIGNTS 55421 . 788-50n4 1 HERHBY GERTIFY THAT TH18 SURYEY. P4AN, OR REPORT WAS PREPARED BY. ME OR UNDER MY DIRECT SUPERVt�ION AND THAT I AM A DULY, REC318TERE0 I.AND SURVEYOR UNDER THE LAWS OF THE STATE OR MINNESOTA. '',� � � oATE t�=� ►�c�4 ._,, � �. � � . , � ��+�� �- SCALE 1,' = 30 , MINNESqTA REGISTRATION NO. 5332 o=1RON MONUMENT � 1CCOw�':o�t. `J i,Z` � ; _ � �. 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"• �•:� •:. -i- > . . . ' ._ ._ - . �.�., .. . . .. -.. . •-:.. - .. _ ��._ . �.- �__ � ,.. � . . - -- -� ' - £ � � �_ 'W.-::�_ _ . . _ ��_ . `f " "" :" ...�� .c .` .� . . " _ " _ __ . ____w ' .- . . . . .__ _ - .. . . . :�� .�... . .. � .r _... .. _.. . . . '_ .. �.. . . . . . . . '_ . _ ., �. . . ��-. ia.=. ' . - � . .� . . _ �.i .' " . .��. � : -, "' r -- - .. . . . .�y >.. "._: "---s� ._ _ .'. __ i _' _ - .-. . _ � T r .� , Y �.. - _ - 9�. - _ - ._ --__. �_ . _.,, - �:xb�,�.;��-�,��. .�_ - - STATE OF MINNESOTA DBPARTMBNT OF NUMAN SBRVICE8 44a LAFAYETTE ROAD �?�� Q' (� ST. PAUL. MINNESOTA Ssf01 —� o . fo Date � - Zon g Authority � `{ � I C�-�...� � . � Street Address rl'� i� � � S '�l �� City State Zip Code RE: ZONING NOTIFIGATI9AT 4� A���A���I�3 FOR LICEA�SURE Subject: �' � %��5�-,. Name of Day Care Home Applicant ��- g .�l- tl n'� � . Street Address � A� , l�i �, S 5`S 3 a-- City State Zip Code � � '►, ' . i � D8S-2722 (9-85) PZ-02722-02 Type of License: Family Day Care Group Family Day Care �-�-�� � Licensed Capacity � � Phone No . '� $ � - � � � � This is to inform you that we are in receipt licensure under Minnesota Rules, parts 9502.0300 Rule 2), Family Day Care and Group Family Day Care this license is subject to compliance with the Statutes, Sections 245.781 to 245.812 and 252.28, the Public Welfare Licensing Act and the rules of Services. of an application for to 9502.0445 (formerly Standards. Issuance of provisions of Minnesota subdivision 2, known as the Department of Human You should note that under Minnesota Statutes, Section 245.812, Subvision 3, a licensed day care facility serving 12 or fewer persons shall be considered a permitted single family residential use of property for the purposes of zoning. Subdivision 4 of the same section indicates that a licensed day care facility serving from 13 through 16 persons shall be considered a permitted multi-family residential use of property for purposes of zoning. If we do not hear from you within will consider the above-mentioned your local zoning code. Sincerely, Licensing Wor er Street Address 30 days after receipt of this letter, we day care home to be in compliance with CO�M�d�UiV��i'f ;�� rta_ ���a t': ; c^��:�AL SER1/ICES D`���f�,;C't`�J i COUNTY OF ANOKA COURTHOUSE, FOURTH FLOOR ANOKA, MINNESOTA 55303 Name of Agency/Organization City State Zip Code AN EDUAL OPPORTUNITY EMPLOYER ADDRESS . PIN . LEGAL DESC . PERMTT TYPE . PROPERTY TYPE , CONSTRUCTION TYPE . CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 s�z-36u4 r��: 528 IRONTON ST NE 033024230064 RIVERVIEW HEIGHTS LOT 53 BLOCK G HEATING RESIDENTIAL ADDITION/ALTERATION s�i-izs� PERMIT NO.: 2004-00161 ' DATE ISSUED: 02/05/2004 �. � � � �- VALUATION . NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERNIISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A REPLACE FURNACE (WARM AIIt, LENNOX, 66,000 BTin AND AIR CONDITIONER # A/C iJNITS 1 VALUE OF APPL OR WORK #FURNACES # GAS RANGES APPLICANT RESIDENTIAL HEATING & AIR 1815E41 STSTEA MINNEAPOLIS, MN 55407-3425 (612)724-1899 OWNER MCGRATH,DONNA 528 IRONTON ST NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or consiruction authorized is not commenced witin 60 days or if constntction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wor� will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law reg�4etmg�onstruction or the performance of construction. Ap licant � � Date � Bldg 1 # GAS DRYERS 0 FURNACE SHELL/DUCT WORK GAS RANGE FEE GAS DRYER FEE AIR CONDITIONING FEE HEATING REPAIRS/ALTERATIONS STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 15806 SEPARATE PERMITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE. 0 0 30.00 0.00 0.00 25.00 0.00 0.50 55.50 � D � 1 � O �� a � � � 3, � � � v'. � �� n � � o � 3 0 .+ Q. � 0 �� � � � A -a °' � � � � � �� 0 � � � m Q � � � 0 c � � m Z N � R7 � 0 Z �'1 m m � .� v 0 0 � S � D a -a 0 < � a � � � � 0 i 00 � 7 v �, m _n � a� v � � D � x � � � , �. O � N 1' � � � � 3 � z � ` D � m � � .D � % � � O 0 �3 � � � \ � �. C O � D =, � � � � � c� O � 0 � � o rt � � `� � m � m � � � � � � � C� � � C � � v► -i '�o=m3 � A � m y m � n ,.�.� �. �' eD m ... oi v, � � � � y W � m rt �� � � ��o� Q- Q- � � °°`'� r.'�m3 ? fA � fl1 � � o � � � � � h � y � °r � � ci ���� w � n �7 ma�-� 1 � o 0 m°'d�' � � e � y m � �- .+ � ca oSi � �: o •-► ? .-�. � � � o W — � rt „n.�. 3 CD � � C_,i �D �� � 0 N o � m � W � Q. N �D r D � � � 3 < � fll N � � � �. � a �' ;� D � � o _. � o � w �� � � 0 z � a c� � � � � � C � � � (' � --i � a m n�, i � 0 K N= � J 0 � � � N � � 7� O � m' o� N � c N 1 � � o�i � N 4► o � � Q. m � j 1 � � N N m � � � � N r �-+ cn � a o °o °o °o � � � C � � '` o � C � O � Z � 3 `� m m � �c � H � � _ o � c� rr � � n n � o p > > � � � � ^ � � Q tn o � �' 3 n rri z v v �o = 0 � m .-�r � m 3 � � � D= � N ..� N .�-�'�� A 7 � �3 � � � m � � -� < � co '� � .,�+ � � 7 Q . � 7 o� .n .. Q. � �=c ° 'a g O� o � �r'°1 � ��W�o ���\� � � ~' v �� � _ � m � � a o °o °o � m � � � o � � N W � c AQ z v� C c�i, v -� � � � �� � m � � � � Z O ,� ..�, � � �. � � A c r +� � -n a� c� � W � w � F�-� v ti� � C � w N � c � � W Z cD �„ rn u, �, v n Fv.. A ��'�t' 17 �- W < -G � N � y v � -p mrn ii � O Z v � a � -o z � � �a �O �� nl .n a� �� 'a °a�� z� v .,o >� � Oy vz �v 0 _� WZ Z �-�i D L� Z v° .v'e � N �'! O � �O (J� a Z �� vs (� � a � C � '��y c� � V f�fJ O �j Z � � w., h; r. a r. � r < r� � c c z � : c c 4 f.-...n .t G� THE BELOW MUST BE FlLLED IN WHEN REP�-p►CING FUEL BURNiNG APPLIANCES OR THE APPL,tCAT10N WILL BE REfURNED •��i�•► 1 ► I i� �►� •: !►� •u= ��� '-: I : � ! �•► Wtten rE �p.rcioy a�..�••� �•� �e undersign� hereby verifies that the venting has t�en examined and is iree f�m n�st, deteria�ation, obstrudions, and is securefy supported and firestcipped whefe require�t. Yes (' � No ( The verrting system is piastic/PVC artd meets aN a�rrent codes and manufacturer speaffcations induding sizing� length, number of elbows and termination. Yes ( No () The undersigned also verifies that the replacement un� is a listed assembiy and m�ts the current codes and manufac�urers specifcations. This does indude AGA-GAMA Category i Central Fumace Venting Tables for ian assisted and natural draft appliances. The ���p cemt��a�en �ir �s sized attd insta0ed to meet the Cu�Terlt codes and manufadurers specifications. WhBri �Ulf@d t0 ins4all a n�w c_emh��etien ai' it WII� b@ SI'G8d 3t1d iftSidll@d to m�t the current c�es and manufacturer's speci�cations. Yes �o ( ) Yes (�o ( ) Yes (�No ( ) � the �tdersignexi hereby ver'�'ies that it is a 6sted assembly and tr�ts the cument c�les and manufadurers " sp�ifications. This d�s indude AGA-GAMA Category I Central F'wT�ace Vent�tg Tabtes for fan ass�sted and natural draft appGancps. Yes (�IVo () Is the common vent and vent cor�nectors s�zed and instaUed correcUy after an appGance has been removed from the common vent and vented separately as per c.ument codes. Yes (�,yKio () ! • • . / ry' /�i' . � • �► ].. .• 11 fl • � " � .. � � ' � � l 1 ��M • IIY� �11 , 1 • � Appli�tce #1 Type -�i� 2,.� � �e- BTU Input 6 6, o � v Fan � ✓ qppGanoe #2 Type BTU lnput Fan Assist� or Nat Applianc� #3 Type BTU input Fan Assisted or Nat T�fal App�'�ces To�! E�a lnPut � Common Vent Type Vent Height Diameter inches Appliaartce #1 Ver�t Conn�tor Height ft Length ft D'rameter in Type Appliartce #2 Vent Connedor Height R Length ft Diamet�r in Type App�iance #3 Vent Connector Height ft Length ft Dramet� in Type — � � r . ► .�- . .,- HEATfNG CO: Signed By: Date : c� � � C � � Z /� � D r r � m � O v m v -� m � C � n � m � O z w 0 � a Z v D � r m rn ,D � � i �.�a � �I � � � fl: rn � c A � n� cfl rn �a � a � a < a � � 0 c � � 5 0 �. � v v M m .��m r �• � \ O � 2 c� °,m� N � � "n � z rn �, v � �Oo ��o m �_ o � -, y v � "o fn �; D � v D � m � 0 Z � � Gi Z m 0 � � m r ZL 0 \ � � � Oi" o �� w Z�' � c c ni `� m" m` ',G � y y (rtD N N � 7 n � � � � v v � � � -, 'a � 3 � � .o � � o � � _m _ � � d W � �' � � ��� oi G�i �j c�i rn t�n, W� �.., � � � � � � < <' N. f=A � N C i i �C �' � 7 (�D Z � � m -o � � m rt y � � w � � cu � �, � -� m � A c'� � _ � � m m a .-. m � � I ol I I I I I I I I I I I � w 0 0 � r c � � Z � � 0 � a z � � � r= C � � Z � "11 -i C � m � m � z 0 ������������ .� � w w w .� � .� � � � � a o cn cn cr� o 0 0 0 0 0 0 -I 0 0 0 0 0 0 0 0 0 0 0 o m 0 o a o o.o 0 0 0'0 0 0 m � � m v � 0 � ^L o. � �� � m � � � Z O �^n ) '`9 `� 6 � "�l �� \J � C � v_ z � c � m v � � N Sv �n � z °' °- � m � v `�- m c � a a n d y wo�� -'� � � v � � � S � s o��� �� �- ��o? _, o m �zz-� �, a m �-`�io o m `e w�� = 3 ro � \ p o � z � �' ,�- �n O � 0� . m �z ? � � _ � � �' �°-. � Q�� � ��o ��� <�O a�� — - �- cfDi c'> � m m � � 1 G ? y � rt � � c'� � � � a ~. m � c� � � � ��`�o � 8 � � a m . y N � O � � O D r L m v v �°''e' FILL IN COMPLET�LY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS � COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacina an existinct furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No () The venting system is plastic/PVC and meets all current codes and manufacturer specifications inciuding sizing, length, number of elbows and termination. Yes () The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. Yes () The existina combustion air isJsized and installed to meet the current codes and manufacture�'s specifications. Yes ( ) When required to install a new combustion air. it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () When installina a new ventina svstem, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This. does include AGA-GAMA Category 1 Central Fumace Venting Tables for fan assisted and natural draft appliances. Yes () Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. No ( ) No ( ) No ( ) No ( ) No ( ) Yes ( ) No ( ) Aqpliance Tvae and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input ___ Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter �in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS• (Describe) HEATING CO: Signed By: Date : ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE CITY OF FRIDLEY 6431 ITNIVERSITY AVENUE NE FRIDLEY, MN 55432 163) 572-3604 FAX: (763) 571-1287 : 528 IRONTON ST NE : 033024230064 : RIVERVIEW HEIGHTS : LOT 53 BLOCK G : PLUMBING : RESIDENTIAL : ADDITION/ALTERATION ._�, PERNIIT NO.: 004-00957 �'' � „t DATE ISSUED: 06/21/2004 VALUATION : $ 400.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A GAS WATER HEATER. # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0 # NEW FIXTURES (EXIST OPENINGS) # GAS DRYERS # OF NEW FIXTURES APPLICANT NORBLOM PLUMBING CO 2905 GARFIELD AVE S MINNEAPOLIS, MN 55408-2173 (612)827-4033 OWNER MCGRATH,DONNA 528 IRONTON ST NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This pernut becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and exa.mined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wor� will be complied with whether specified herein or not. T'he granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulatin co vction or the performance of construction. Applicant ' Date � , Bldg Insp 0 # GAS WATER HEATERS 0 # GAS RANGES 0 # WATER TRMT APPLIANCES PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) PLBG FIXTURES (EXIST OPENINGS) WATER TREATMENT APPLIANCE WATER HEATER - ELEC WATER HEATER - GAS GAS RANGE FEE GAS DRYER FEE PLBG REPAIR/ALTERATIONS STATE SURCHARGE, PLBG FLAT TOTAL PAID WITH CHECK # 28495 SEPARATE PERMITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE. � 0 0 0.00 0.00 0.00 0.00 0.00 35.00 0.00 0.00 0.00 0.50 35.50 e 2 - '7�� �1�,�,�.g .spection�s ,�-���-�604 � r+�v�s._._ �s a��carrr �s: CITY QF FRIIlLFf ��.���ir �islilFrNiii'f►�. t� ��.�1..�►. �. j�� C;� +C)� Fit�A��Y . YOUR E�fAIE. AADRESS . C� �V�� . . � �� .� «• • ' (p 5��- 3 �emni.t NQ.:, Received BY:�� R Da�e i�e�'d: r - � � °� BR.TY ovV1�1E1K/ �,e,�„¢: rn ��- a�•• � , • C ,.� - .^- - _ TENAN'�' C1TX SFAiE � annRFSS• �xc�: v . � 7 svaM�rr• a• �co��T�r oy��. ��%� O lA�L YM�,u� WTIH AP�'I.ICA'i'IQN PROP�TY �� Q� 57'AT£ LICEI$E ■ : .i ��a , tiy i �:� > .�.+x���. �%Q� Br�C7 �IZE OF �NlPROii�7'�' �; • - a , � . � ..��. a� , rw� - . •..v�r i:� r �IIVG 7 �►"my1 7 A1wn�im�AU► 7� Od�er.� w � �+1G �GS �Yes ONo �R �RN&W OP,9�id�-�� � � �P�TiII3Q�&--------- ar�, ��.s � V; Pla�a �eviow Surchar$e Fire Su�rlaazge i.icense Sx�ac�r�e SAG Charge C:rub Cut Esacow ;�rosio�u Gc�atrol Park �� Sewer M�va Gl�arge /p gII�fdG ��tf.�y,g��+y+�++v+� �� ❑ l�i'.l'4V ;� i' C7 G�e LENGTH y � HOUSE �HI.Y ❑ HOUS£ Bt GARA.C� � ATTAC�3ED G�A►� D DE�AG�.D GARACE �Qjlt�'.i��Il�l��� -�v�� T���,�� ■�� r.�' ..•-� �. 1 • la. � / / � �. / I l �'. � � O ���iT.J� i R1�Gl�JiGlifYfa��� 1. fi�8� Pian 2 Prdposed SaA P1�n 3. i.�E vEstrncAnral members to ba tsed FORNb'W G'ONS'�RIJC!'IQN 3NQ.UDING �: & B Tr�► 1. Sioc P1�JSuveY sh°�mS ths c� � ❑ F�cie � F�Po� P� 2. T�v s� af aoeshuaios � 3. �YY � LOCATION f�F WII�IDDWS va�,v�,�orr, n�c��ruaavc x� cos�e oF {LTSII�iG T� 1997 U.S.0 FEE SC�"D�E3 -�-- �- Se� Sack Page for �ea Sci►edv.�e $ 65%ofBuildie,gPenu�iR ��e $ • a1 �T'�— (-ppp� �eg the total job valvation — �um $.50 $ o .001 x Peimit Val�tioa (1/10%) $ � - C $5.00 (S� I,fcensed R�sidentiaa Co�o�) g $1450 per SAC �(P1� 40 NI'VVCC for deRer�Ai�oation) � R+6g°,..�.�ftx$20=$ $ $450 Ca�sse�vadan Pla3a Review $ �ee I7�� bY E�'� $ Agreement rn�' ( ) Nan Ner.essarY ( ) � �7 1Vf�ke s�tecks pa3�abfe bo: Cit�► of �'�id1eY Attas � T[i1S TS AN .A�L�ICA7T0'l� FOR A PERMIT NOT VA1.ID UNi71- PROG6S55D I herebY aPP�Y for a b�uiIdio�g per�nit and � a�cknowledge t�at �e information above is annplete �d a� �� a►ork wlll be m confo:me�ce wfth tha � and codes of the City 4f £ri�dle�y a�ad with the Mmonesota CAn�on Codes; tl�at I w�d�nd this i� not a pernc►it but an'fy an epplica�on foz a pexmit mad wurk is not to start without a�ermi� ttm t�e worlc will be in acaordar►ce wi� tb�e spproved plan in t�e casc af all �vozk w�t �w�approvai of p�ans- --� � �� �/ ��j/ /���.�� / % .. n _o . _ ,� _ _ s,. .�., ,., o � 2 �.. _ ia �' 11e'iF � % V /O SIGNATUitE OF APPLiCAN1'