AF - 47403City of Fridley, Minn.. �
�. _.`
BUILDING PERMIT N° 5 3 9 5�
nate: ..._�.. �_�... . ..i _.�'" _�._ _.�...____._.__.__ �
Uwner: --� -• •-- --.�. Builder ...-•---._._.. ._.._.._.----...._------•--...----•---.._..�----•---•--•----..__.._.._..__�
Addre�s ..._._.._._ .............__..._.___._.___..__.._---__..........._.._..._.._..__._..----.._ Address ._.. . _ .._.._--•--------.._.__._.__._.__.
,� L ATION UILDING
No. 1R.. ��.-..1.�... Street •--. ... . _ ... _ .. .---_ .�,�. P of t ....._..._......_..:._..... ._.
Lot ...�f�'!_".�.�.. Block ._......---• -----.--..._...------------ Addition or Sub-Divi� on � • •--..- -
Corner Lot _..._ ............._......� Inside Lot ....._.....i�!'!�"..........._ Setback .. ��-...._.___.� Sideyard •---..�Ll.....__..._._....____.._._.._._�_
Sewer Elevatian _..._..__....._.___..__..._.____..._...._.__...___..�_.... Foundation Elevation ___--•._._...._.__---_..._.._..r.._._.�..�._
�
DESCRIPTION OF BUILDIN� ���
To vsea a �r ,,,.�, �j
_.� _.. . Front _..��. , Depth .,�r._� Height _� Sq. Ft. .L#1...R.�Cu. F't ���C ��
....�_._._._..._.._._r:_._.__._._ Fro ...�.� Depth _.._..�... Hei t�..__....�. F� _.._._.._.._ Cu. Ft _.._..
Type of Construction .�ji--�= -•�. Es� Cos ........ To be Compieted ....._.._..._..___....�..._._...
•��-..�!�'
�"
�-r �� ,
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the prnposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
.�••••_._....__ _---
In consideration of the paymettt of a fee of $ .....____._.., permit is hereby granted to.�____.._.._
....._....._....._......._._.._...__..�...._....__... to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding lceation, construction, alteration, maintenance, repair and moving of buildings
��th�e city limits and this permit may be revoked a t any tim��po� v,,tolation,p!'�y of the prov3sions of said
�I�I ,rr" E
� �
J• il rr' I' 1:
NOTtCE. ; . rv� �
This p�rmit doss not eowr th� eonsfruetion, iaahUafWa for wirtn�. plumbiny,r;sas bsalieg. s�w�r or wat�r. B� sun to s�a
ths Bvilding In�setor for sspuate p�rmifs for th� ff�ms. " .
- - i �` � - - � 3
_.
_.
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APPLICATION FOR BUIIAING PF�II?
CITY OF FR,IDIEY, M�NNESOTA
Owner's Name Buildex'
Address Address
No.
Lot ��'—' �,,,� Block
tion or Subdi
Corner Lot �Inside Lot � Setback�„�_ 3ide-Yard �,�,r ,�
SEWER ELEVATI0�1 FODNDATION ELEViTION
�pplicant attach to thia form Certificate of Surney of Lot and proposed building
location.
/
To be �ed as : _ �
DESCRIPTION OF BIIILDING
�. �. � � �'r� � �u. Ft. .�,�6a=
Front , Depth Aeight
Sq. Ft. Cu. Ft.
�ype of Construction Eatimated Cost
To be Completed
The undersigned hereby mRkes application for a permi.t for the work herein speai.fied�
agreeing to do all work in atrict accordance with the City Ordinances and rulitig of
the �epartment of Buildings, and hereby declares tha.t all the facts and representations
stated in thia application are true and correct.
DA� -- ,�„ f SIGNATIk�6 �
(A Schedule oP Fee Costa can be found on the Reverse Side.)
-. _... �
� < � '�r
+t • s a- �. �!
City of �ridley
APp�icatiae for P'I�umbing and Gas F�tting Penr�it
Dept. of Bldgs, Phone SU 4-7470
DESCRIPTION OF WORK Location � `� /�
Number, Kind and Locatioa of Fixtures —r �
� U I �.. I� � I � 1?(� � 10 � I �LL � IS � I< 3 IC<9 4 I(�9 gn IU' O I F I N I GASTER ELEC.
Base
lst
2nd
3rd
4th
• Future Coanectioa Openfngs
* New Fixtuze, Old Openiags
PARTIAL RATE SCHEDULE
3ewer �
Cesspool j'�
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number F`ixtures . . . . . . . . . . . . . . . . . . . . . . � x $1.50 $�� � Q
Future EYxture Opening ................ x 1.20 $
New Fixture Old Opening .............. x 1.00 $
Catch Basin .... . ..................... x 3.25 $
Water Heater (Up to 200,000 BTiA ...... x 2.00 $ 0 �
New Ground Run Old Bldg . . . . . . . . . . . . . x 3.25 $
GAS FITTING FEEB: NO. RATE TOTAL
lst 3 Fixtures ....... ........`... ..... x $1.50 $�"
Additional Fixtures .. ........ .......... x .50 $
Gas Range to 200,000 BTTJ . ... .. ..... ... x 2.00 �
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL �'EE $�a• v U
City of Fridley:
�
c�
�
�
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the facl
and representations stated in this application are true and correct.
Owner
Kind of Building
��%� �
Used as ��"Cx-C^^"'°�
/
To be completed about —
/
Estimated Cost, $ � �s
(3�d—New. Building Permit Na �'�^`� �`-' Pe�it No. �
�a.C�a'�-�l't.f G� ".k::� �'c �.._ I � � , �K
5igned f �T ,
gy � [ d ���-�-1— ,_.,
� �7 M ,ry
Business Phone No. � �-3 f��
ROUGH rJ " .2 7 � lo�
FINAL
az 2M .
�
•
� Ci of Fridle Minn•
� y�
BUILDING PERMIT
� ���✓
N° 7183
Date: _�:'-�-' � _....._...._
�
.
Oarner: ��._ _.. _._._.._.. Builder _.._.__.��� _.___......... ..___.._...._._..__......_.__
Addx^e�a .._.__._�.._._._...�...._..______._._._..___._._.._.__.._..____...__._ Address _.._._.___._.�...._._______._..,_.__.._..._.
CATIO F BUILDING
No. _[�. .. _. . ...r._.__.._. Part o U ._.._..__...__.._.._.. .
'��..�Street . .._._ _ . _. .. ,� '
_. .
Lot�.i-...1�.1__ Bl ._..__..'�_._.._...___._._.W._ Addition or Sub-Di ion .. _ __
s
Corner Lot _.___.._._.___ Inside Lot .._.__� ._.._ Setback .,�' _.. ._.. ._._._._ Sideyard __.�.�
Sewer Elevatian ._.________..�__........._..___._.—.._._....__.__.._._ Fo da.tion IIevation _._.._ �._ �
DESCRIPTION OF BUILDING
To U .
_. ...._ Front � Depth ..�_, .�._ Height ..,�.�c._._ Sq. FL .�i! Q..�? Cu. FL ;r-�c—�
__.___.___._�,........_...___ Fro .....____.._.__ Depth ___.—. He ght _._... Sq. Ft. G�. F't. _
�...�_ _._.._._.._.
Type of Construction .._._.__ . _ . ..__.. Es� C ._ . .. ..... To be C�pleted .._._
� . �� ..__. __. .
In consideration of the issuanoe to me of a permit to construct the building described above, I agree to do
th� proposed work in accordance with the description above set forth and in mpliance with all praviaions of
oidixiances of the dty of Fridley. � 1� � //
�__
In ca�sideration of the payment of a fee of �� �___.._.., permit is hereby granted to.— --- ----
to construct the building or addition as described above. This permit is grauted upon
the express cbndition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and up�t said building, or any part thereof, shall oonform in all respects to the ordinances o�
Fridley, Minnesota regarding lacation, construction, alteration, maintenance, repair and moving of bufldin�s
within the city ]imfts and this permit may be revoked at any time upon violation of any of the provisio�s sa�d
ordinaucea �
�S ��
• NOTICE:
ihis p�eroit doa not eov� 11N eon�, te�hll�Na� fw vrklnY. P��Y. Ya hwNn�, srwK or wabr. M wn �e s»
th� duildfno imp�ero� for ap�rat� pwmils for fh�a ibm�.
v�
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`�.. �� � � � � i J .
OWNER' S 1QAMB �o r��l.,.-t �h
APP'�ICATION FOR�BUILDING�PE�MIT - 7
, . , CiTY OF FRIDLRX, . MINNE$QTA � . , .. . '
• . .. � _ . � .�,..
I S ��/I ) ol�l ; $V��� � ( , 6 4 c! �. �. • ; ( /� a /) �i23 oc� ;
ADDRESS ,�"�/1.�+ l�r_K�� I�f •�% ADDRESS 1a�L��_�FL�C/.�3�.. ::� .��L�G
: , _ : , . ; LOCATION OF BUII.DING ; � � , .:
No. G~�/��w, ._ ff�,�C� Street � ,-z ,_T a�t� of Lot
Lot � Blqck � !� ^Additian or Subdlvis� � . � : ��. , . :
Corner Lot��Inside Lot,�_Setback ;--Sida�+Ya�. .
SEWER ELEVATION, FOUNDATION BLBDATIO�
Appll�ant attach to ,this_ ��rm Taro .Cettificates of : Surv+ey,, of: -Lot� , apd .,pa�opo¢ed build-
. . .. . .:
; .:
" i�ig location drawn �on: these Certificatea.- . � � - - � :
- . . . , r: .. , _
.. .. ; : .,,. . , .. . -=; ,. - _
DESCR.IPTION OF BUILDI�G f . . .
y;,:,-; .. ';}
To be used as: `" �
�' . . ,,; . �
/j . . � . • . . . . . � , . � : . �,
.1G� �� � (_�_�F �5�„_,�:, . . Fr+�ut ZD Depth , ,Z ,� �_HeiBht' � �
��—
, . � : _ ,, �. : , y/'^
S:q t� � Cu. Ft -_3�, �,,,.� 6
. •� \ F.� �� � O� �. . � �'-� " �i..�r�r
, _ ,giant � Dspth� r Height'. , .
: . . � S.q.� Ft,. �, : �� Cei,,, Ft. .. . .
;
Type` of Construction �,r���' � � Estimated ,�qat . -.�^
. . . _ . . : ` ;-Y �. . .. . "� ..
To be 'Completed . .
. , ,_
, . , „ � : .. ;.,.
.
, , . , .. . . . .: .
The undersigned hereby mske`s appl�icatioc� for a p.ermit fQr the work �ers�n epeci#ied,
a$reeing to do all work in strict accordance with'tfie City of Pridley Ordinances and
ruiings �f the.Departmeat of Bu�,�.diags, and hereby dsclar�aa that akl.,�he f�cts and
representatious stated in this application are true and co;re�k.
Z�
�(Schedule of Fee Costa can be found on the �eue�ae Side).
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j,F•Q;.ic;,T►o��� FOR Pwr•ialw� hN�Q Gns 1=irr���„ P�:�.�.,� � .
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w+c.r a..lten.e
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lle.���,; N�teC lla�tee
�S 1IIfIt:G F�ES:
l�t 1 f�.turss �
tii.t►►i�nal ft.tucas
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,__ x
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RATE TOThI.
53.00
�2.1i�
52.00
ss.00
55.00
510.00
57.00
SS.00
SS.00
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5
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5
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�_ x $3.00 g
x 51.00 S -T-
_,__ x S 10 � 00 g �_-
S�aco Suc:herga
Tu[�.L � �.L'
i5.o0 '
SZ.Q�
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5 _ a.00
Jo� n��«�5 6l�15 N.E. Jaekson
' �.�.�.
Dcpartmr:nt ct b�i.:,+,:���y
Cll'y ct ['ridl�y . •
Tel. p571-3•150
7'hu�und�ry1gnad I:.:reCy �r::kea appli.-cc_or :�r e:,:�n,t� C,;r tl,: �
epnclfled dgic��i�� �� ,�� �1: wGtk !r. Sti:;t c:_cr�sr,,:o wlcl. �1,, � �� L�LL'y
end r�ltnys cf th� Ge�:ar�mcnt oE 81i:��n�;, _-� --rCc :
Clio f�clu a��d re��r��„rt.��lona y[atad � �'��l�re, cLet at ;
. lr. thlr ;.i,:.:c�t1c�: aro t�uc nnJ �:�.i,,,,,,;
. Ft:.11uy, .:r.. ���3�� _ lI_______
cwNea �nene Sewert
KIt�D OF UUIL'uI:;.; F'i'3IRe r
usco ns Res T
TO DE COi•IPLCTEG h:,CU P Jr�2-� ~
ESTI�V�TL:D CU5'P �� �
OLD - tIL'HI UUI4GItJ.; P:.I.:.tIT ;�.;, —_— j�
FE(�•f: :.�.
�:.s�[:�r�y _ :�
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':al. 170.
, R�OUGII I IISP . .
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ht�{•IiUVAL t'GR (•EW1i'C ��
MIIIIMUII 1'L'C I�.p 1�11' PLUi:utt�:. FCf�:IP IS S7.:J FLUS ;.;0 ::�.TC iUkC11I,1�f.0
sue�ecr P
City of Fridley 2 6 8 3'2 �
AT THE TOP OF TME TWINS g U I L D I N G P E R M I T
� • T NO.
� �
� • COMMUNITY DEVELOPMENT DIV. /
' j V _ (
r � � PROTECTIVE INSPECTION SEC. �
1 �
l--._� �'��,•� CITY HALL FRIOLE� 55432 NUMBER pEV � OATE PAGE Of AGPROVEO BV
i 612-571-3450 9t0-F15 7/27/98 / /
JOB AODRESS
6415 Jackson St
1 LEGAL LOT NO. , BLOCK TRACT OR AODITION SEE ATTACHED
DESCR. 2O 2,1 +1/ Alle 4 Florence Park Addition to Fridle SHEET
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
Ph llis & Dan Co ess -
3 CONTqACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Panelcraft of 721-6628 2179
4 ARCHITECT Ofi DESIGNER MAIL ADORESS ZIP PMONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE IICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW O ADDITION O ALTERATION � REPAIR ❑ MOVE O REMOVE
B DESCRIBE WOFK
Sidin • soffit• fascia• trim
9 CHANGE Of USE FROM TO
STIPULATIONS
Call for inspection from building wrap before covering.
TVPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PEAMITS ARE REOUIRED FOfi ELECTHICAL, PLUMBING, HEATING,
VENTILATING OR AIF CONOITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 OAVS, OR IF CONSTRUCTION
Ofi WORK IS SUSPENDED Ofi ABANDONEO fOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCEO. NO. OWLG. UNITS OFFSTREET PARKING
I HEFEBY CERTIFV TNAT I HAVE READ AND EXAMINEO THIS APPLICATtON 1 • STALLS GAfiAGES
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VAlUAT10N . SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED
WITH WHETMER SPECIFIED HEREIN OR NOT. THE GHANTING OF A PERMIT $9049 9.04 Fire SC
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMIT fEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- t�,�g�
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. ],(2.25 S���F.S2,
PLAN CHECKFEE TOT FEE
Licens 5.0 180.81
SiGNATUAE OF CON � RACTOR OR AUTMOFi12ED AGENT IDATEI EN RO E ALIDATE TMIS IS VOUR PERMIT
� �
SiGNATUREOFOWNEA��FOWNEABUILDEAi IDATE� BL �NSP � qoTE
iv I��v I I
nDDN ��
ni� rc►z i I
Cc�iistructicm /lciclresti
CI'I'Y Or I�RIDL�Y
SINGI.I: I�AMILY AND UUPIICXI:S R-1 AND R-2
Builclin�; Pcrtnit AP��lic.ilion
�l � �l� ����
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L'IIt;CI►VC I/1/J�}
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Lcbal De;scri�tion: -------- -- - ,
Owncr Naine & Aciclress: �%J �/��+� _� !? �vd /�,,o � S � _ Tel. �l v� �/ '' � / �o I�
/ �-
Cc�ntrac;lrn•: _�GT�i'!z%/CHQ���� /1%�/1�----- MN LICLNSC lI �/ 7�
. Aelclress: � ��� � � �/�r� 4 Tel. Il
0
LIVING A2CA:
GARAGC ARCA:
UCCK ARI:A:
�TI-IrR=
U
Attach to this aPplicalion, a Cerlificate c�f Survey of die
lot, �vith tlle Proposed consu-uclion drawn on it to scale.
Lengtl�
Length
Length
DCSCRIPTION Or IMPROVLMLN`I'
� � � /�a �
Wicilh I-Ieight Sq. Pt.
Wiclth Heiglxt Sy. rt:
Widdi HbdGround Sq. rt.
' Corner Lot ( � Insicle Lol ( � rt. Yd Se�back Side Yard Setbacks _
o� �i'L�%"F 5��6+- %r�•�, Estimalcd Cost: $ 9p `� `� ° °
'I'y�e oi� Cc�nstruclion: Si �n�. o� { •
A����rox. CoulPletion Dtite: �
(Cost on Dack)
llrivc;�vay Curh Cul Wicith Nccciccl: �t. -h G l�t = I�t x$ _._ _� � _
llA�r�: _ �/ 3 �_ APPLICANT: Tel. �� 7�/ " � �0�8
C1TY t1SlL' ONLY '
Permil 1�ee
Pire Surchar�;e
Siatc Surcharbe
S/�(; Charl,e
Liccnsc Surc:hart,;e
D�riveway rscrow
�rosion Ccmtrol
P��rk T�ee
Scwcr Main ('h:u�};�.
-roz•n�_
STIPULATIONS:
���a s
�---- 9 � `�
�----- � sa
�----- --
� 5", o0
� -_
g_ __-------- --_
�___--- --------------
� ��'����
� �J��
�ec Schcdulc on Reverse Sidc
.001 of Permil Valuation (1/101h°lo)
$.50/$1,000 V�iluati�n
$$00 per SAC Unit
$5.00 (State Licensec( Resiclentia( Contr actors)
Alt. °A" or Alt. "I3" Above
$450.Q0 Conservation Plan Review
ree Determinecl hy �nbineerin�;
!\�;rcc�ncnl Necc;ssar-y I I N��t Nccctisaiy I I
. ..
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sue�ec* PE
City of Fridley _ 8 74 �
AT TME TOP Of THE TWINS g U I L D I N G P E R M I T
r
; � NO.
� ; y__._._ COMMUNITV OEvELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. ��O �
i . .
i-__-�'��"';'� CITY NALL FRIOLE� SSIJ2 NUMBEA NEV D�TE v�GE Oc •VPROVED 8r
L 612-571-3450 9�0-Ft5 12 14 98 � �
J08 ADDRESS
6415 Jackson S r
t LEGAL �OT NOzO � 21 � BLOCK TRACT OR ADDITION SEE AT7ACNE0
DESCR. SHEET
2 PROPERTY OWNER MAIL AOORES$ � PMONE
�1 Donald Coppess 571-3160
3 CONTRACTOR MAIL ADORESS ZIP PMONE UCENSE NO
Town & Country Roofin 7910 12th Ave S B1 omin -
a ARCHITECT OR DESIGNER MAIL ADDFESS i1P PMONE LICENSE N0.
5 ENGINEER MAIL ADDRESS ZIP PHONE IICENSE NO
6 USE OF BUIl01NG
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage (28 S) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TVP�OFCONST OCCUPANCVGROUP OCCUPANCVLOAD
SEPARATE PEFMITS ARE REOUIRED fOF ELECTRICAL, P�UMBING, HEATING.
VENTI�ATING OF AIR CONDITIONING
THIS PERMIT BECOMES NULL ANO VOID If WOfiK OR CONSTRUCTION 20NING SO. FT CU fT
AUTMORIZEO IS NOT COMMENCEO WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANOONED fOii A PERIOD OF 120 DAYS A7
ANV TIME AFTEF WORK IS COMMENCED. NO DWLG. UNITS OFF$TREET PARKING
I HEREBV CERTIfY THAT I HAVE READ AND EXAMINED TNIS APPLICATION STA��S GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORFECT. ALL PROVISIONS OF �AWS yA�UATION SUpTAI(
ANO ORDINANCES GOVERNING THIS TVPE OF WORK Wl�l BE COMP�IEp
WITM WHETMER SPECIFIEO HEiiEIN Ofi NOT. TME GRANTING OF A PERMIT $2399 $1.20
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TME pEqM17 fEE SAC CNARGE
PROVISIONS OF ANY OTHEi; STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR TME PERF RMANCE OF CONSTRUCTION �]�F.75 Fire SC �Z.�FO
PLAN CHECK FEE TOTA� FEE
License SC 5.0 83.35
S�GNATUQE 'a , OaAUTMOQ�2ED�GENT IOATE�
WHEN PROPERLY A�IOATEO THIS IS /YrOj' R,PERMIi
.- Lr/� G�y�_
S�GNSTUA �OWNEAii�OWNEpBU40EA� �D�TEi . � BLD ���NSP' - � �i�TE
De�!- 14�-98 09 : 30A
� NEW [ ]
• ADDN [ ]
ALTER [ ]
ConstructionAddress: �
Le�al Description: _�
Owner Name & Address:
Contractor:�� �
Address: i G � t'� l,
LTVING AREA:
GARAG� AREA:
D�CK AREA:
oTxER:
CITY OF FRIDLEY
SINGLE FAMILY AND DUP%EXES R-1 AND R-2
BUILDING PFRMIT APPL,LCATION
��� SJ ✓1
-�- �r- �e
�'�l
�
P.06
Effective l/1/98
��
�1 %
� �3e
Te�.�r S�/-3/(0��
rt MN LICENSE � �;)�j��''J/ a �
� � a��/d Tel. # ��/S'` �/;� 3-�
Attach to this application, a Ccrti�cate o�' Survey of thc
lo[, with the proposed construction drawn on it to scale.
DESCRIPTION OF llvIPROVF,MENT
Length Wid�h Height Sq. Ft.
Length Width Height Sq. Pt.
Y.ength Vlridth Hgt/Ground Sq. Ft.
- „ �,� � x� �
r
Construction Type: ���� Estimated Cost: $ .�y �0 / , .S�
(Fee Schedule on Back)
Driveway Curb Cut Width Nceded: Ft. + 6 Ft = Ft x$ _$
DATE: .�- / Gj � APPLICANT: c Tel. #�Y,� - yd 3�
Permit ree
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
S'fIPULAZ'IONS:
� 7�
$ '�
$ /. 2C>
�
$- . l�`�_
$
$
$
$
$ �3. 3�
CITY USE ONLY
Fee Schcdule on Reverse Side
.001 of Pcrmit Valuation (1/lOth°lo)
$.50/$1,000 Yaluation
$1000 per SAC Unit
$5.00 (State Licensed Residentiai Contraccors)
Alt. "A" or Alt. "B" Ab�ve
$450.00 Conserv�tion Plan Review
��ee Deterrnined by En�gineering
Agreemen[ Necessary [ j Noc Necessary ( �