AF-M - 47623SUBJECT P E
City of Fridley Mo�i� 19571
AT THE TOP OF THE TWINS ���; j�]`i��X P E R M I T
r �
' ' R
� � •
� `L ___�� COMMUNI7Y DEVELOPMENT DIV. ��//�
r � � PROTECTIVE INSPECTION SEC.
� � ,
' � /'��1 � CITY HALL FRIDIE� 55432 NUMBER REV. DATE _ PAGE Of APPROVED 8V
�""'�� ,�� 612-571-3450 910-F15 / /
JOB ADDRESS 5708 Jefferson Street N.E.
t LEGAL LOT NO. BLOCK TRACT OH ADOITION SEE ATTACHED
DESCR. 2�3 4 Adams Street Addition sHeeT
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Martin Gavik
3 CONTqACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Bahl Movers Inc. 141 - 90th Avenue N.E., Blaine 786-5650 105
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE UCENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION ❑ REPAIR �.] MOVE O REMOVE
8 DESCRIBE WORK
Move Garage Out of City
9 CHANGE OF USE FROM TO
STIPULATIONS
Route; Jefferson Street to 57th Place to 57th Avenue to University to
Mississippi Street�b Silver Lake Road to Out of City.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULI AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCEO WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO 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 COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERMITFEE SACCHAFGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $1S.00
T UCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECKFEE TOTALFEE
$15.00
SiGNA URE OF CONTRACTOF:OA P.UTNOR4ED AG T 1DATE� , ` WHEN PROPERLY LI ATED THIS IS YOUR P RMIT �
SiGNATUREOFOWNERiIfOWNERBUILDERi IDATEI ' LDG WSP qq7E
� � Moving January, 1988
[ ] Wrecking City of Fridley
N17VIl� CR WRDCT� APPLICATI�I ,
Job Address: � � � � � �c !' S � S ~� �
Legal Description: �� K a� I�� u��e �..r4 �,
Owner Name & ess: - - #
Contractor: Gi.� � overS c. ��? 5�6�5�
Address: l`� [_ �v� c�c,c e(l%� �. �qi � e. state Livense # �� S^
� a. «; �y �,� �, :. �r . ,.
Living Area: Lengkh Width � 8eic�t Sq. Ft. _. (1�. Ft.
Garage Area: Length �� Width a.Z i s Hei�t �_ Sq Ft. Qi. Ft.
.
Other : Length width Heicj�t Sq. F't. C1i. Ft.
�1y.1�+;
Estimated Cost o�f Wrecking/Moving Approx. Campletion Date
Utilities to be Notified:
City Water/Sewer Mpls. Gas Comariy Northern States Pcywer Northwestern Bell Tel Co.
571-3450 372-4720 566-9120 293-0665/2y3-1.i19
Water Bill Paid: Yes [] Amamt To Be Collected [$ ] Initials
Ma�illg ROt1t2: 3ie��trS o., S{. i� �. �� �
, ,
cis`� c. r. V�� c
�.•�l�' o�v � , _ '�o �° r-�-�n o
� p
!, �� _ S:�uer' �4�< i��,
C��- � o F" r� � '.
. .�
Maving. Principle Building into Fridley .... $ 60.00
Accessory Bui,lding iryto Fridley .... � 20.00
�roucjl, wit3�in or out � City .... S 15.00 NaNIN�JM FEE: 515.00
Wrecking: For eadl 1,000 cubic feet or fraction . S 1.25
For structures whidz would be impractical to cvbe, the fee shall be based on the
total oost o�f wrecking at �e rate of 56.00 fo� eadi �500.00 or fractioa�.
4he t,uidersigned hereby makes application for a permit to wreck/mwe tt�e building described
above, agreeing to cb all work in strict aco�rdanoe with the City Ordinanoes and rulings of
�e Building Departrnent, and the State Code which requires any water well on �e p�operty
to be sealed by a state licensed water well driller, and hereby declares that all facts and
re�esentati�s sta,, ' r appl icati� are true and correct
. ���� �.
PEEt1�9.'P • ���. d(� . Sic�ature
� - Sti.pulations. � ��� �o.�-cn-5 �v�c. �
..._, ,.