P - 41799Building
Inspections
763�572-3604
763-502-4977 F/t�
DATN, .�' l ".. ,/J
SITE AUUKGSS
THis APPLICANT iS
PROPERTY Ov
TENANT
CONTRACTOR
SUBMTT A COPY OF
rCii iR STATE LrCr;NSF
AND CERTmca,T� OF
lNSURANCF,
PItUPH;I{'l'Y 't'X A"�:
TVPF ()F
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From: 9524433205 Page: 1/2 Date: 317/2011 8:35:16 AM
�U�LDING
�t�SIDE�tTIAL A,�'�'LICA'�'�UN
CITX (1F FRIDL�Y
F.FPECTIV� 1-1•2011
1'OUR E-MAIL AUI7RE$5
IIOWNFR ,�ONTRACTOR
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ADDRESS;�•/ �'r-r�r� roYt S'� C[TY �'r ��G„�I ,�.�y STATT�'1l�z1P�o"�
PHONE: `7le 3- �+ �7_�SSr� PJ �g'�
STATE LICENSG u �� ��o _.'�'�,0�3� I „ LFAD CERT NUMI
APnRFSS:��7_.S'` f�.�« � ►�T� A� -- CiTY,
pHa� �lr�—�9a'—�/G� FAx S"2—
a'`�1NCi4G t'n �rvrw CuNSTRUCTION 5iz�
CI' II.YlNEw CONSTRUCTION S'I'ORiTS
� a�n►r�ON ❑ GaR.aG�JSHH � vv�rvno�
��SA56MENT FIIJISH � ROi7R I'1 T7RAtN.
O vECK ❑ SIDINC '�(OT'
C7 SWiMMiNG POOL
�NEW itOME CONSrRUCTTnN � ADD�Tipw
(vIAfNTF.iNANCFJREPAIR C1 RFM0I�ELING
F• �'� �. �.s.� �i �, n .� i. Jr_�I..t! 6/Y! d Q,v /��! A O..i Y'
�OF1NG
N17MSER OF S()UARES �,,,,,,,,,_,
�
PRQPp$F..D SIZE:
PRpPQ56D HEIGH7:
SiD1N('
❑ w�yi
❑ Aluminurn
❑ Okhcr
WIN.DO�
EN CXISTING DPEN[NGS DYcs �Na
OR FOR NEW OPENiNGS-DFSCRtBE SIXk AF
OPL:NlNG CFIANGF,S �
ALL
TO'f'AL JOB VALU
Permit Fee
Plan Review
Firc Surcherge
uurchargc
i..icense Surcharge
sAe charge
Curb (:ut r'scrow
Erosion Control
Park Fee
5cwcr Main Cha�ge
❑ HOUSE 4NLY
C] HOUSE & G�RAGF,
O ATTACiiED GA[tAGG
❑ DETACHED C�AitAGE
�
Clsoffit
O Trim
❑ F.zecia
LOCATION OF wrwnf3wS
■}�/i��l+.► - 7
_ �
0
�}g,�MENT REMODELiNG SUB.NJlT.;
1, ' Fxivdns Fioor Plan
2. Propvaed floor plan
3. Li3t of slruCittt�al membcrs m bc uscd
1'OR NfiwCC1NSTRU�'7'ic�N INCLUOINO DECk:3.
ADDTTiONS. Rt PORC:HE�,^qIJ�{,�;
1, Sitc Ptan/Survcy showing the existing snvctur�
snd prcKxrscd projcCk
2, I'wo sets of constru�titm p1Ans
3, F,ncrgy Caiculuiions
FOR wTNC�OwS — PRC3vtD� U-VALUG AND
0
MANi1FAt'Tt1RF STICKRR bN WINDOW.
ON VALUATIQN, xNC�.U�1�NC THE CpST OF LASOR AND MATERf
I/� 1NG '�'iiE 1997 [J.B.0 FEE SCHEDULE)
' 1 1�� li�i C)("['i iPA1VCV TYPE
Ce�,: F3ar,.k page f�r PPe Scheciulr.
65% of 8uilding Pennit Fe�
.D01 timcs the totat job valuario
.0005 s Pcanit Valoation M imum $5.00
$5.00 (5tate Licensed Residential on� rs)
$2230 per SA,C Unit (Plssns to MWCC for determin�tibn}
ft+bft= ftx�Z4=$
$450 Corlsetvation Plsu� R.eview
Fee Determincd by Enginecring
Agreement necessary ( ) Non Necessary ( )
Make claecks oavable to: Citv of Fridlev Airac
THTS i5 AN APPL[CATION FOR A P6RMIT-NOT VALiD UN'fiL I`ROCLSuGD
T hereby apply for a building pccmit a d C�CnOwledg � the information above is complctc and accurate; that the work witi be in
conformance with the ordinanees and e es o e Ciry ridley and with the Minnesota Canstruorion Codes; that I understand this is nvt a
permit but only an appliattzion for a pe it d ork , at ta start wlthout a permit on site; that thc work wili tro in :u:c;c,n��ncc with lhr
�pproved pian fn the case Qf all r v' w and approval of plans.
51CNATlJRE OF APPLlCANT IM NAME (%�irrt%G I'�,���ilyr� DATE �'�^ !%„�.
A1•PIidVAL INSTGCTOR SiGN '[IRF /lil �
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