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Inspections ,
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From: 7637121835 Page: 2/2 Date: 11/30/2009 3:57:11 PM
B�TILDII�I+�
�SIDEI'�T'I'IAL .�FPLICA7f'IC�I"�T
+CITY OF FRIDI.,E3�
Permit %To.:
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�a.� � l!�" �_„� YOUR E-MAIL ADDRESS m� c.ti c 11 e@ e x t e S m r. c o w-+ _
szz�aanxESS 1n80 Jane5v',1�e, _Sk NE F�-�d�e� , ttiN s543 2 _.--. —
THI5 APPL3CAiVT IS: II OWNER
PRUPERTY OWNEI21 NAME:_ To m�1 Ju�_ Sti u i?-v� ,._,_.,— —
���� ,ann�ss: l0 8 0 J4 � csv i►1 e S�h N E crr5r 1� r� d� c y s�rA�'!�ire 554 3 Z
rxorrE: '� � 3 • �t 8 4 � 2 34 "? � .
corrr�AC roR �a,�:_ � x c e ►� a d� n �
SUBMIT A COPii OF STATE EdCENSE #__ Z d � to 2.1 Z� _ EXP DATE 3 � 3� 1 O 9 � N �T
YpUR STATE LICENSE �n��� '� 0 0 Bu ��e r(..lC C31 V c1 N W CiTY
l�'YtOKA STATEM��IP 553Q3
WlTH APPLICA7TON pxorre "1 l0 3�'�112 • 0"i S"7 FAx '7 l0 3•'Z 12 � 18 3 5 -
.1 o�AS�����
❑ DECK
Cl DItAiN TII,T
Qo�
DE�CR]BE WORK BEINC3 DONE: Y-S 1 Ll l h� W i h d u W�D 1 U C C 1�n � ri��
SIZ�3 OF IIviPROVEMBNT LENCiTH WIDTH IiETG�IT . Fi. �
SQU.�tES
�
PROPOSED 3IZE:
PROPOSbD Ft$IC3HT: ___,_
❑ IiOUSE dc C3ARACiE
CI A'iTACEIf�� GAAAGE
Q DETACHED L3RRAGH
Vinyt QSoff'it
❑ AIum�mim t] Trim
C1 4ther � Pascia
iN'W3
�STINCi OPb"1VING5 �yes QNo LOCA'T'iC7PI OF WiT1DOWS
OR FQR NEW OFEIVINGS-rifi3CRIBE SIZE QF
OPEMN� CHANGfi3 8c ,`
TXPE OF WINDOW TO BE INSTALLEDV \�1Y �����ER OF WLfIDOWS ��,
ALL FEES ARE BAS�D ON ALUATIQN, ]NGLUDING THE COST OF
' (I75 T 99'7 U.B C k'EE SCHEDUI.E}
TOTAL JOB VAI,UATI41!T $- -- --- _.G� � OCCUPA.I�TC'
Permit Fee
Plan Review .
P'i.re Surcharga
Surcharge
Licens$ 3u�harge
SAC Char$e
G�ub G'Sat Escrow
Erosion Controi
Park Fee
Snwer Main Charge
�'r!4s��i�'�'� �6�OD��jNO SL��"r'=
2. F..a�sting �toor Pian
2. Proposed itoor plan
3. List oPstrachu'a1 memtrers to bo used
FOTt NEW COIVSTRUCTIUN 2NCLl}D1NO DECKS,
�ln,l,�ITTONS ,�P�,P�RCHES SU�MiT_
1. 3ite Pian/Survey shawing the e�oistiag structuros
and proposed project.
2. 'i`9ro sets of oos�x'uction ptans
3. En�rgy Catculations
/_��7
______.___�__
$ �t (�a See Hack Page for Fee Schedvle
� 65% of Building Permit Fee
$����y.lM�. 001 times the total job valuatzon
$ .0005 x Permit Vaivation Minimwm $.50
$ $5.00 (State Licensed Residentzal Contractors)
$ $l 675 per SAC Unit (Plans ta MWCC for determination)
� R+Sft= itx$21 �$
$ $450 Coz�.servation Plan Reviaw
$ Fee Determinad by Bngineering
� � AgreernenC necessary ( ) Non Necessary ( )
$ ��'�h�.�V�._�� Agaka checks navabic to: Cify of k'ridlev A�c
THi$ IS Ai�I AFPLICATION FOR A PSRM[T-NOT VALID UNTIL PItOCSS5E17
I hereby spply far a building pezmit and I aclmowledge that ihe mformation a�bove is compiete amd aecuxate; that ihe wozk will be i
canforrnance with the ordirzanoes and cades of the City of Friciley and wst� the Mumesota Const7vction Codes; th$t I understartd this is not
p�rmit but only an appliastion for a parmit and wack is not tra siRrt withmrt a permit; that the work wi11 be, in accordance with the approve
plan in fhe case of all work whic u•es review and appxovsl of plana. '
SIGNATURE OF RPPLICA1a17L� ��' `y� PRiPiT I3APllE 1�'f ! C I'1 e i� (�e {�► DATE ��,_.��.�,�L.�._