AF-W - 47405sue�ecr IT N .
City of Fridley w�ECKIN� � 217 6 6 `�`
AT THE TOP OF THE TWINS ������� P E R M I T
� ` RECEIPT NO.
� • COMMUNITY OEVELOPMENT DIV.
' j L ����� , �
r � � PROTECTIVE INSPECTION SEC.
� , �'��1 � C�TY HALL FRIDLEY SrJ4.3Z NUMBER pEV. OATE PAGE OF AVPROVED BV
�'""'�"� �'' 612-571-3450 910-Ft5 3/22/93 � �
J09 ADDRESS 6431 Jackson Street NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO
oescR. 22,23,�t 2, B.lack 4, Florence Park SHEET
2 PROPERTY OWNER MAIL ADDRESS IIP PHONE
Tim Fowler 6431 Jackson Street NE 755-9678
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same 11103 Cottonwood NW, Coon Rapids 55448 538-3778
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS Of WORK
O NEW O ADDITION O ALTERATION ❑ REPAIR ❑ MOVE �7 REMOVE
8 DESCRIBE WORK
Wreck a 22� x 22� Attached Garage
8 CHANGE OF USE FROM TO
�'TIPULATIONS
Clean s.ite o� all construction debris.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUI�iED FOR ELECTRICAL, PLUMBING, HEATING,
VENTiLATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY 71ME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTHEET PARKING
I HEREBY CERTIFV THAT I 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE Oii CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- y5`1Se OQ.
STRUCTION OR THE PERFOPMANCE OF CONSTRUCTION.
PLAN CHECK FEE T07ACL FEE
y�ZJa ��
S�GNATURE OF CON' CTO OR AUTHOR12ED AGEN7 IDATEI EN PROP LV A IDmAT THIS IS YOUR PERMIT
_ � � 34 2 3 93
S�iG ATURE Of pNJNE i�F OWNER BWLOER� �DA�E� DG �N P � q4TE
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�nvn�c a� � �c�zaN
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�qal D�s�'ipcion:
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oo�tractor:�
Adcir+es.s : ri /� �:
0
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State Lioense #
Tel . #.�r.! ���� r O
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� T�. � .
Living Area: Lerigth Width Height Sq. Ft. Cu. Ft.
Garage Area: Length o2� Width r- �. Heic�t �� Sq. Ft. �� 6,� C1i. Ft.
Other: Ie,t�gth Width Heic�t Sq. Ft. Cu. Ft.
1
Estimated Cost of WreckincJ/�"�vu'�4 Approx. Ocn�letion Date �- lc�cJ�
� �� • :�- • ■ ���,
City Water/Sewer Mpls. Gas Canpany Northern States Piow�er Northwestern Bell Tel Co.
571-3450
[ ] 372-4720 [ ] 566-9120 [ J 293-0665/293-1319 [ ]
Water Bill Paid: Yes [] Amount Zb Be Cbllect.ed [$ ] Initials
N4wing Route:
FLES
Maving: Principle Building into FYidley .
Aocessory Building into Fridley .
�, within or aut of City .
. . .
$ 80.00
$ 20. 00 Miiiiaman Fee: $15. 00
$ 15.00
Wrecking: For each 1,000 cubic feet or fractiari .$ 1.25
For stnictures which wnuld be impractical to c,vbe, the fee shall be ba�sed on the
total oost of wrecking at the rate of $6.00 for each $500.00 or fraction.
Zi�e undersigt�ed hereby makes application for a pexmit to wreck,/mwe the building described
ak�we, agreeir�g to do all w�ork in strict aocon�anoe with the City Oniinanoes ar�d rulinqs of
the Buildincl De�artme-nt, ancl tlze State Oode which r�, i r,� �y water well o� the P�Y
to be sealed by a State lioensed water we11 driller, arid her�y declares that all facts and
repre.sentations stated in this application are tnie ar�d oorrec�t.
�v U _ / /.y`_' �rC.�� r�9�—`
PEE�IIT FEE:
� — sicp�,ture
8'1'IPtJIATI�LS:
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