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AF - 47374. u City of Fridley, Minn. BUII.DING PERMIT N°• 3 8 2 g Date: ....� . �.a...� ............ � .!�%?/, , Owner....................................... Builder ....... .. ... � Address ...................................... Address .� � . � . .........r!'.N'f. 'Y� �" _ / Y�3 L.O�CAT[O�V OF BUILDING No. �.✓ f.�... Street ... ... .........f�../.l..� . Part of Lot ............................... Lot .'........... BYock ..........:....... Addition or Sub-Division ....................................... Carner Lot ............ Irrside Lot ............ Setback ............ Sideyard ...................... .. DESCRIPTION OF' BU[LDING To e Us .. .... •� �. ��t .Y.f.!-o � .a.�-o " tl.�d. �,��!a�o �.$ �� pth � Height .`.%�.�t 5q. Ft. (,ix. Fk �. . .. .. . Front �6.. ... Depth ��.`� Height `ll. .-.d Sq. Ft.�� . G�. F't. �aZ.Z� Zj�pe of Construction . . . . . .. .. . . .. . .. .. . Est. Co�t. .�,�� i� d. c�..�. 'o be Completed . ............... ... �•�% ��% � -3 -GG� .�.r��2 �/�� v�,-� �% �� In consideration of tne issuance to me o! a permit to construct the building desribed above, I agiee to do the proposed work in accordanoe with the descr3ption above set f a� iy.�compliance wit� all provisiona of ordinances of the city of Fridley. /I I I�1 J. �. l/ � .�.� .7•`. ,%�C: . . . . . � a. .'. .�.`.�.� . . . . . . . . . . . . . . . . . /,, Ort1 In consideration of the payment of a fee of $�5�:.'..-.', permit is hereby granied to ................... ...... ... .. .. .. .. ... .. .. . to construct the building or addition as described above. This permit is granted upon the express condition that the person to whaan it is gi�anted and his agents, employees and worinnen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinanoes of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- ordinances. �ts and this permit may be revoked at any time � n violation offany of the provj�fons of said If'— ./ f NOTICE: �� /I / . • .► • sIC $ti31t13ng InBpeCtoT This permit does not cover the construction, tnstaliation or alteration for wiring, plumbiny, gas heatin�, sewer or water. Be sure to see the Building Inspector for separate permits for these items 4 �1 -. �f �� I :,� � w� �� ► y�.� Ciiy of Fridley � �{� � . . . . . Ap,p��c�a�tian far Pl�mb�ng and� Gcrs F�tt�ng� Rerrr�t � Dept, of Bldgs. Phone SU 4-7470 DFSCRIPTION OF WORK � /' 1e- Number, Kind and Location of Fixtures Locatio��S ,� /� �� C�� s�� -�/' ��''� � (� � Z S N Z Y y=j } Z� � 3 u � m� � N 3� o� Base /,i � lst 2nd 3rd �4th • Fuiure Constec3ioa Openi:tgs � New Fixture, Old Openings � � WATER HTR. � � Z V Z� N �n � U' Z M :k _� ~ j< Q a < Z `� a F N GAS ELEC. �n LLo t�� 43 (9Q C94a (90 � � PARTIAL RATE SCHEDULE Sewer � Cesspool f1 PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures . . . . . . . . . . . . . . . . . . . . . . � x $1.50 $ �d • �G Future Fixture Opening . . . . . . . . . . . . . . . . 2 x 1.20 $ � � %6 New Fixture Old Opening . . . . . . . . . . . . . . x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTCT) . . . . . . x 2.00 $ � • �_ New Ground Run Old Bldg . . . . . . . . . . . . . x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL lst 3 Fixtures .......................... x $1.50 $ / -•S7 Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU . .. . . . .. . . .. . . x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description .... ...........................................� .� .S% O�� TOTAL FEE �� City of Fridley: The undersigned hereby makes application for a permit for the work herein speciPied, agreeing to do all work in strict accardance with the City Ordinances and ruling of the Department of Buildings, and hereby declares bhat all the facts and representations stated in this applicatio�n are true and correct. Fridley, ,��. AUG 3 1959 , �s_. Owner �' � �� L �`� , 19— Kind of Building ..l� � , 19, U�a � �D w To be completed about � � � �� , � Estimated Cost, Old—New. Building Perxnit No. � `' � si�n ONDON PLUMBING C0. By ' ay�"` Business Phone No Connection Permit No . ....................................................... AUG 11 1959 ROLIgh 11 1M-8-58 Water Sewer Meter Deposit , �, � SUBJECT �--�---�_, City of Fridley . 1508 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r � � CEIPT NO. � `L __��_ COMMUNITY DEVELOPMENT DIV. � r � � PROTECTIVE INSPECTION SEC. 1 i �4 � /"'1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF� APPROVEO BY ""'� � ,�� 612-560-3450 910-F15 3/13/79 � � �oe ,000aESS 6311 Jackson St. N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 21,-23 5 Florence Park SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Michael Niedenfuer 6311 Jackson N.E. Fridle 55432 7- 3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO. Home Modernizers 1158 Thomas St Paul - 4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE IICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WOFK InstalZ Aluminum Soffits 9 CHANGE QF USE FROM TO STIPULATIONS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAO VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNiNG SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT jj-1 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPUED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT ], S DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUC710N OR THE PERFORMANCE OF CONS7RUCTION. PLAN CHECK FEE TOTA� FEE � S URE F N TOR �AUTHORIZEDAGENT IDATEI WHE OPERL A D THIS IS YOUR PERMIT �- l.i- � �l Z`7 % SiGNATURE OF OW IIF OW BUILDEHI IOATEI BL G INSP nATE CITY OF fRIll�EY ' APPLIC/�TIOP� FOR RESIll�NTIAL BUII_DING PER(�1ITS . ' tNCI�, nLTCRATIONS, I�DDITIONS,� OR REPAIRS) � . . OWt7ER: mic�.�A�� I�rDC11J CtifA� SUILD�R: ��ql� �DF�r�%/Z�i�Gd / / 58 T��s 5 f �v , Address : (� 3� � y�_ Ac3dress : :� Tel. IGo. V t%s� �iO.i^�` • . No. : (�'S � 1 Street : �. i�C.ILSO� LOT: BIACY.: J�DDITION: C012NER LOT: INSID� IAT: S:sTBACK: SIDEYARriS: Applica'r,t attach �to this foxm Ztao Certificates of Survey of Lot and proposed building location drawn on these Certificates. . DESCRIPT�ON OF BUILDING •� �o Be Used As: .. � �,[.t,�. SuCG 1'i'� Front: Depth: � � Height: Square Feet: Cubic Feet: Front: � Depth: � Height: � Square Feet: � Cubic Feet: � Type of Construction: a(. � Estimated Cost: $� O. ON Zb Be Completed: �pG (��S Alt. A AZt. B Proposed Driveway Wi.dth If New Opening Is Desired • . (SEE F2EVERSE SIDE OF SHEET) The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that•all thc facts and representations stated in this application are true and correct. See reverse side for additional infozmation. DATE: 3^%Z• 7 / SIGNATUl2E: Stipulations: : �. S � �0 - '�,'OQ /, � �! .�� ."�� 9. 7 �� palj�L AC�J�r� IMVj� �/�l �� . . � . �I � t SUBJECT � � P �• City of Fridley 2 2116 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � � RECEIPT NO. � � � • COMMUNITY DEVELOPMENT DIV. -.�,^ f � � `�: ------� r � � PROTECTIVE INSPECTION SEC. ��1'� � � � �� /'�'1 � CITY HALL FRIOLE� 55432 NUMBER pEV. OATE PAGE OF APPROVED BV �""� � ,'� b�2-571-3450 910-Ft5 9/20/93 � � JOB ADORESS 6311 Jackson Street NE t LEGAL �OT NO. BLOCK TRACT OR ADOITION SEE ATTACHED oesca. Pt 21, 22, Pt 23, Blo k 5, Florence Park Addition to Fridley SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Russell Puchalski 6311 Jackson St NE 574-0110 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 AFCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE IICENSE NO. 5 ENGINEER MAIL ADDRESS Z�P PHONE IICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WOHK ❑ NEW O ADDITION C� ALTERATION ❑ fiEPAtti ❑ MOVE O REMOVE 8 DESCRIBE WORK Install sliding glass door 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plan. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY IOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBINCa. HEATING, VENTILATING OR AIR CONDITIONING. TNIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WOFK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEFiEBY CERTIFV THAT 1 HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $7OO $.rJO WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T fEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULAT�NG CON- $19.00 Fire SC $. %O STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. P�AN CHECKFEE TOTALFEE yS2�.2� 8i NATUF7EOFCON�AAC OAF�U ORIZEDAGENT IDATE� WHE PE V ALIDATED THIS IS VOUR PEFMIT RE OF O ER nF OWNER U�IDEAI IDATEI BL G IN �FTE rtEw A ADDN ALT�R tl [l [l Effective 5126l93 CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Perrnit Application Construction Address: � : Legal Description: �r j � j,. Owner Name & Address: � Contractar: � aaa��: 5� � � LC� � e � LIVING AREA: I.ength GARAGE AREA: Length DECK AREA: I.ength OTHER: ��U �.�._ Atzach to this application, a Certificate lot, with the proposed �onshvction dra DESCRIPTIUN OF � lia�) �� MN LIC'ENSE # Survey of the on it to scaie. Tel. # ' Width Height � Sq. Ft. Width Height _____' _ Sq. Ft. Width gtlCnound Sq. Ft. �1 l� �'U �� l9 SS a/L ( q 0 Corner i. ot [} Inside Lot [] �t. Yd Setback 'f�+pe of Constructian: Apprax. Completion Date: Side Yazd Setbacks ° Estimated Cost: � %C� d��' (Cost on Back) Driveway Cvrb Cut Width Needed: Ft. + 6 Ft = Ft x$ = S DATE: — d U� APPLICANT: " Tei. � S� %�- v// d Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Uriveway Escrow Erosion Control Park Fee Sewer Maia Charge TOTAL S � O� � �7a $ , ..��Z> $ $ S $ $ $ � �� -�U • M ' J ��:i �'�I Fee Scheduie on Reverse Side .001 of Permit Yaluation (I/lOth%) $.50/$1,000 Valuation $750 per SAC Unit �S.Od (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above Conservation Plan Review $450.00 Fee Detemii.ned by Enguteering Agreement Necessazy j� Not Necessary [] STIPULATIONS: � ' f,��-�ti �f ; Z- Z�i�� #2�f� �� .j � � _ � � � � �� ` � � ' ��-_ ��. � `� �e�� - � ` �� -��- ��a �� . �, �, 74'� �-��- � � 2 �- q'� �� e �, . SUBJECT . PE�?��"#Q'�-"�� City of Fridley AT THE TOP OF THE TWINS T 1 r ' 2 2 5 7 O ' ; , BU ILDING PERMI RECEfPT NO. � �` COMMUNITY DEVELOPMENT DIV. r � L � PROTECTIVE INSPECTION SEC. �O'� s � � � � /"'1 � CITY HALL FRIOLEY 55432 NUMBER REV. DATE �AGE OF APPROVEO BV �""�' �'' 612-571-3450 9�o-F�5 5/26/94 � � JOB ADDRESS 6311 Jackson Street NE t LEGA� LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED oesca. pT 21-23 5 Florence Park A SHEET 2 PROPERTV OWNER MAIL ADDRESS ' IP PNONE Russell Puchalski 6311 Jacks — 3 CONTRACTOR MAIL ADURESS ZIP PHONE IICENSE NO. Same 4 ARCHITECT OR DESIGNER MAII ADDRESS ZIP PHONE UCENSE NO. 5 ENGtNEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Construct a 16' x 12' Deck 9 CHANGE OF USE FROM TO STiPULATIONS WaRHI�� Before digging call for atl utility locations 454-4002 REQUIRED BY LAW r TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTHICAL, PIUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCEO WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WOFK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION 1 STALLS GAF;AGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF IAWS VALUATION SURTAX AND ORDINANCES GOVERNING 7HIS TYPE OF WORK WILL BE COMPLIEO � 1, 489 �. J�F WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT DOES NO7 PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGU�ATING CON- $3S . OO Fire SC � I.. �19 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $37.23 Si ATUAEOFCON'AACT aOA UTHO IZED4GENT IOATE� WHEN P lY ALIDATED TNIS IS YOUfi PERMIT / ' �^ ' l � " ,�J'�� S�GN uAE OF p ER UF OWNER RDERi �DnTEi .-_ ��-� - tDG �rvS �arE NEW ADDN ALTER CITY OF FRIDLEY SING[.E FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Appiication Effective 1 / 1 /94 Construction Ad�tress = �._�C' S' .m � ^ ----�-� � t_ � _ _- -��- ------- Legal Description: Owner Name & Address: Contractor: �.2 � Adciress � LIVING AREA: GARAGE AREA: DECK AREA: OTHER: �( � � S r Tel. # o`� 7�-- Cj i �(� MN LICENSE # Tel. # Attach to this application, a Certificate of Survey of the tot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length _�_ Width �'�_ Hgt/Ground �`� Sq. Ft. j 5�.. Corner Lot {] Inside Lot Ft. Yd Setback Sic�e Yatd Setbacks Type of Coastruction: —�,. �, Fstimat,ed Cost: $ 1��`�1. �7 0� `, Approx. Completion Date: � .e� � � � �'fl (cost� on Back� Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ DATE: APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPUL,ATIONS: , �� $ S� $ , $ ,� � — $ $ $ $ $ $ $ I � �ITY USE UNLY _$ Tel. # Fee Schedule on Reverse Side .001 of Permit Valuation (1/IOth%) $.50/$1,000 Valuation $800 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Detetmined by Engineering Ageement Necessary [] Not Necessary [ J � � � , D � � . _ � � .�� `�/ - �'J OX � ^� o �� »�i� �`��"'�� S 1 n�` � — �; � � s,� � �- �i _ o c� � x _ � �'6 - � � l — � k / � � � _.._--� � ( '� _ ✓ __ _-------- � Z � i � � � � �o � r =� 1� � � � . � � � � - � 9 � , � �1 _� � _ \�. ho � , �i _ ` � � � � C� � .�, 1 ��' �. . �� \� � � � � � � � � � _� � i/ , � � vo � � �, � � S ��-��-- \ ' � �� sue�ecr O. City of Fridley '� � � � ;�3 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � r � ' RECEIPT NO. � � � COMMUNITY DEVELOPMENT DIV. � � ti.------ � �/!J� r � � PROTECTIVE INSPECTION SEC. 1 i ( � �"��1 � CITY HALI FRIDLEv 55432 NUMBEA AEV DATE �AGE UF APPROVEO B� �""�'� �'' 612-571-3450 9t0-Ft5 5/6/97 / / JOB ADDRESS 631I Jackson Street NE t IEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 22- Pt 21& 3 5 Florence Park Addn to Fridle SHEET 2 PROPERTV OWNER MAIL ADDRESS ZIP PHONE 3 CONTRACTOR MAI�ADDRESS ZIP PHONE UCENSENO Steven Woods Construction 6830 Beard Ave N Brookl n Center MN 55429 6810 4 AFCHITECT OR DESIGNER MAII. ADDRESS ZIP PHONE LICENSE NO. 537-2664 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUIIDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION O ALTERATION ❑_ REPAIR ❑ MOVE O REMOVE X 8 DESCRIBE WOAK Reroof Hosue & Gara e(ZO S) Tear-off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAO SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THI5 PERMIT BECOMES NULL ANO VOID IF WORK OF; CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WiTHiN 60 DAYS, OR If CQNSTRUC710N OR WORK IS SUSPENDED OR ABANDONED FOF A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTFiEET PARKING I HEREBY CER7IFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GAFAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SUFiTAX AND ORDINANCES GOVERNING THIS TVPE OF WOfiK WILI BE COMPLIED �1 � FjSO $. H3 WITH WHETNEF SPECIFIEO HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL lAW REGULATING cow- �54.00 Fire SC $1.65 STRUCTION OR 7HE PERFORMAN E OF CONSTRUCTIOM. � PLAN CHECKFEE TA�FEE S 6 License C $ .00 $61.48 S�GNATUFlE OF CON'RAC10A 0�7 AUTMOA�ZED A.GENT . 1 AT I N A �V VA I ATED THIS IS VOUR P RM �./C � ' SiGNATUREOFOWNEPi�FOWNERBUILDER� (DATE� 8 G �NS� � q�TE \TEW ADDN ALTER [� L � CITY OF FRIDLEY ,�-- 3" SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: �o� I Legal Description: � Effective 1/ 1 /97 �� Owner Name & Address: S Tel. # Contractor: '�.V`C�.� � 0 0� U MN LICENSE # fO l� Address: �p � 3 � � V` �° �� Tel. # Attach to this application, a Certificate of Survey of the Iot, with the proposed construction drawn on it to; scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: DESCRIPTION OF IlVIPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Construction Type: ° r Estimated Cost: ��5� (Fee Schedule on Back) Driveway Ctiub C�t Width Needed: Ft. + 6 Ft = Ft x$ _$ DA1'E: � � APPLICANT: S��I'Q� W� 6� Tel. # ur3%�� 6 6�/ Permit Fee Fire Surchazge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIf'ULATIONS: � CITY USE ONLY $ ��,� Fee Schedule on Reverse Side $ ��vs .001 of Permit Valuation (1/lOth%) $ $.50/$1,000 Valuation $ $950 per SAC Unit $ �, 0(� $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ � $450.00 Conservation Plan Review $ Fee Detemnined by Engineering $ Agreement Necessary ( ] Not Necessary [ ) $ 0