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P - 46506Frorn: unknawn Page: 2/2 Date: 1113I2011 1:06:09 PM _ __ _ .__._W_.�._. Build�ng �3uILI)I�TG Tn� #�ons � � RESID��'�'�,A,�,, A,PPL�CATIO►1'� 7��-��2,���4 ��r� o� ��r,E� � '7fi3-5�2w4�377 F AX �c� 1�1_z�ll Da� __ �t.1.�1�� SITE ADDIi�S5 � �-rrs ,v�,�c,�r �s: �►ito�E�� ow�v�R �v�a1vZ' Cbr1'�'RACTOR SUBMIT A CClPY �F i�Qi_P,(� S�?A'fE LICENSF AN� CERiTFICA,'I'E OF IN3LifLAN�E nESCTt�E wORx sEn�c Y11TJ� �'r�ftliI, ADDRES'S _T � OWNER ' 4�1'I7.iACTOR r,�.� a� ,4nnrc�ss: �D � `� �, �zorr�:: l-4lf� xnsu�: �o�� C � SY'ATE LIC�NS.� �1_��i�%�JS t t � � _LF' nnDx�ss: c�i "T6'.ux'^�i� ,�i(� . .. P�QNE ��o�"��- �(�� � .,tivGi..� rAN�.1 /NEVV cortsz'RUCITON � Q TWO �A2vbLXR+TEW C�NSTR�"C;TtON 5' Cl ADDITlON 11 G�.li4sH/SFIED O BASEtv�N'C FTiv►S�i @ if�1C3F O DECK � gffj�� � SWLiv��TGPS70L � NEW HOi4JE CONSTRUCTl4N 0 AbDITTON G MNNTENa►v�p,� p IiEMOp�LlNG E: �Y►i , M\ �M1rsu..al. cL fl�fl� OOFF . NUM9ER OF SQUhRES �� .(3 �Rn _T;a PROPOSF.A SIZE: . I>ROPOSET� FiExGFii; _W` � tiv _ ❑ v� C7 Alumitnue o� �, ixt EX[STYNQr OFENINGS �Yai [INa oR FpR N£'w O1�tvl�dG5-DE5GFt�8 SxZE OF GPEN1Ntr C1iAI�6ES dt 1'1&11 Revtiew F'tte Su;�harge 5urcharge �.iaens€ Stucharge SAC Charge Curh C:rrt Esc�rt,W, Frosion Ca�l Park Fe.e s�'cr ldleir� Cl��e $ ON o�xc vsE oxr: x ausa a� �ax.,�cE O A,T�'ACFik';A Ge1RAGE Ir7'�i�TAQ�II GARAGE aSoflit a rr�, a ���;� LC�CAZIQN pF w�NDpW5 �ERdF WtN�x�wa (uu1NCs'�` 1997 U B.0 FEE SCi�DiTLE) C�tT Q� L�A.�T T�T.D Cl OTHBR Perinit Received By:, 1. 1Exiatmg 1Fkor rlan 2. Proponted floot plan 3. List at' �uepu'�! mem6as tn be �tld PO�t NEw �ONSZRr�CATt�N fitta..cmzNG 17EC.I4�, Bd�kTII0IN5. dt I+OItG'i�s crftiir.rrr• 1. Site PLnl3urv�y ahawiag the�i�timg PtructurGt �►a propo9a� oioix�t. 2. Tao sefa afea��,�, p�� 3. £ne�gy C�Jcuia�i.m►s FOR Vi�NDt7W5 –FR4v�3E U-VALUE A� MANt�"FAC'x'f.�`,fi 52ICtCER PN WINb�OVT. -- See $ack Pa�e for �'cc Scheduyc _ 6S9�o of�uilding Pe,�ntit Fee _.001 tix�es the to� j�ob vaivation ,� .QfJOS x P�ii Vsiva#ton Mi.a�u,� $5.0� ' ,_ $5,0� (State Licensed Residenti�l Contractors� _$2230 per SAC Unit (P]sns tio MWCC for determznatirni) _ �Pt * 81t = �� tt x �25= $_,,,`� $�450 Comsetvatiou �1&n Review _ Fee Detecrnit�ed b�' Er►Biaecring Agreement necessaxY ( ) Nozi NxessarY ( ) � 1R_\__ _�_ _ ..• � _ _ . . _—__--_.. �� a���n.vu�I ikA$ IS AN AF�PT.Tf'A97(1N FhR A'P�P,ivdT-1VOT VALfD Y�'N7'!x. FROCESS�! i hereby ap�ly fo� a building pe�mit ai,d I aeltnowiedge that f�e i�lforn�atian abwe is completc and accetcate; th�tt thc wotk Wil1 fae � confo�nance w;th tl� cmlinamces and codes of the City o Fzidley snd wxth the 1Vli�esota Construetio� Godes; tlaat I u�d�tand t�is zs �ot a �Ut �}, O�y 87f A�iirafjflm fOr a w�Dt�1C � t'tp al�t w�tj�Oqlt 8 t� aPI�� piau in the ca.se a war1� . . . k�uit on site; rb;ax r;he work w111 be i�,� acccnd�uce with the 3IGNATURE QF APPLYCANi � BPPT�Vg1 Of �7 s. APPR�V AZ, $35PE�TOR SiG � 1RF . �T ��— ���'' �_�' DATE i I� v�IE�