AF - 47662�
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City of Fridley, Minn.
BUII�DING PERMIT
�te: . .� .��. . : : �. � : : . �.�. . . . . . .
Own�r .......................................
Address......................................
�
N° 3498
Builder. e�.. ...... . ......... ...........
Address ...��� ...............................
LOCATIO�V OF BUILDING
No. . . !. �l. . . . . . Street . � / . . . . . . . . . . . . . . . . . . . . �!� . . . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . .
Lot . �� . . . . . . Biock . . . . � . . . . . . . . . . . . Additlon or Sub-Division . � . . . . � . . . . . .
Corner Lot . . . . . . . . . . . . Inside Lot . . !�. . . . . . . . Setback �`S. .—.d. .n. Sideyard l �1. . :� � . . . . . . . . . . . . . . . . . .
ti
DESCRIPTION OF' BUtLDING
To be Used as: /
!Q,G,��-e.��. ... �ont '�l : i�1� ne�tn a� =lD Height �9..-+� 4sq. Ft. �� � .yca. Ft. �C�Oa23�
. .. . . .. .. .. .. . � . . . Front . .. . . . . . Depth ..... .. . Height . .. .. ... Sq. F't. . .. .. .. . G�. F't. ..... .. .
Type of Construction ... ................ �st.
In consideration of f1�e issuance to me of a permit to consl
the proposed work in accordance with the descrlption above ;
aidinances of the city of Fridley.
�. .
'�'� To be Completed
%�.... ........ .........
above, I a�ee to do
with all pmvisiaa�s of
......................
In consideration of the payment of a fee oi $ �� � . . , 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 worlmnen, fn all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinsnces of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of bufldings with-
in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. �-
. .� . . . . Building InapecCor
� �e
NOTICE:
This permit does not cover the constructton, inatallatiov�or alteration fo� wl�inp, piumbiny, yas heatiny,
sewer or water. Be sure to see the Building Inspect'�r for separate permits for theae Items.
City of Fridley, Minn.
BUILDING PERMIT N° 5514
nate: _..._�... "."..._:.....,����''.".'_"_�.W._.._.. .__._ .
Owner: ' __ __ ._.. :���I'�� ..._.._.. ._ ._._ Builder .. ... _ . _...._........ ._.. ...__.._ . � .._..._..._._
Address....._....__._._._.... _..---_....__.._.._.._......__._.__...._....__.._.---..__... Address _.__.._.__._.._._..._.._.._._.._..._.._.._..__-----__..__.._._..�.._....�_._
LOCATI O U G
No. .,�,�1.�..._. Street . ._ .,�'�;,�!�y�"� .. J��'�•�IPart of t_..__...--...._..._�______.�._
Y�
. Block _---•---..._.-•,,l-•-•-.------•--:--..... Addition or Su . .on ....._. ..._.. ......_.
Lot .....-•-----�-....__
... . .._._ �_.__..___.._.A—.�
Corner Lot ...__...._....._..___ Inside Lot ..�-=--.._....._---!'�tback _... ... Sideyard .......�.._..
Sewer IIevation _..._..___.._..�.._....__..__..�..._...._:•...._-----._....-----_ Fo da.tion Elevation _._____------__.�_..___._.._.._........_.._
DESCRlPTION OF BUILDING
T :
_���� .� _ Front r'.. ..__ Depth ''�".�!.'_'_ Height {�, ...--.. Scl. Ft. j�*..��#r Cu. Ft �
.___.____._ .____....._____._ _..�__...._. Depth __..._. eight _.. . Sq. Ft. _._..__._..._.. Cu. Ft .....�
Type of Construction _._y�; .!._.��V!,�.. Est. Cd�t �..(��-___�...�.._.._�...- To be Completed ..___...______._...__._____
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
./�_.._....._
In cansideration of the payment of a fee of $_:� '""f ._.__....._.., permit is hereby granted to..._..
...._._.._._.._...._._._.___...._..___..... to construct the building or addition as described above. This permit is granted upari
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform fn all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving , of buildinga
within the city limits and this permit may be revoked at any�j,�rr+a.ug,Qn,,,yio tierr"b# any of the provisions of said
ordinances. Yl// / !
Bt�ildin8 Inspect�
NOTICE:
This psrmh doss nof eovsr th� eonstruNion, inslal{aiion fo� wirio0. Pfu�pbpiy, gas Mafing. »wsr or wat�r. M wr� to sw
th� BuiWing laspecror for s�paroM pormits for thu� if�nn.
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�DD. �--�� �-!��`�� TYP.E ?�-�'�-t...
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Date:
Ovvner: Jerr�Chlebe�k Builder �th - Hook
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City of Fridley, Minn.
BUILDING PERMIT
� June ].t�, 1965 ��
-� .� � �7�
N° '7862
i
�
Address � Ke��a�tc�n __._._...___._..._____.. Address ..-1s__��.s., �! ___.._____
LOCATlON OF BUILDING
No. ....._..�._.� Stceet .—_�._.._.._.._....$�.,�.�_....._..__._...._._..._.._. Part o! Lot _
Lot �13 .�_..._.__ Block _�' .�._..� Addition or Sub-Division . B��'� T6='TatCe
Corner Lo�t __�.._.�.._ Inside Lot
Sewer IIevatia�
Setback ..�.__..._....—_._.._ Sideyard
_.__ Foundatioa� IIevation —..+.
To i� vsea �:
._._.._..._. ._._ F�o�t
.._.___�____..,..___ Front
Type of Construction �......_._.
DESCRIPTION OF BUILDING
Depth Height ...� Sq. Fk
Depth ._._ iieight _ Sq. F�
.�... Es� Cost _....�l�� __.____......_ To be Compieted
cti. �t.
Cu. FY.
8epair �tox� Damage
In cozisideration of ti►e issuance to me of a permit to c�struct building described aba�►e, I agree to do
th� prop�aed work fn accordance wTith the description ahoaT� set fo and in coinpliance with all pravisions of
ordlnances oi the city of Fridley. (� ��'�.*'" _. . _ � � ! �
In caa�siderat[� of the payment of a fee of � �'� , permit is hereby granted to
3�a3.'i�h & H�Ok to construct the building or addition as described above. This Permit is granted up�
the express canditiam that thepereon to whom it is granted and his agents, einployees and workmen, in all wark
done in, around and upon said building, or aqy part thereof, shall c�onform in all reapects to the ordinanoes o�
Fridley� Minnesota regarding locatian, construction, altera.tion, maintenance, repair and moving of bufi�in�
withiu the dty li�nits and this permit may be revoked a t any time upon violation of any of the provisia�s oi sa�d
ordinenoes.
�l17.1.�II densen B��g �
NOTICE:
iWs p�rmir doa not �wr fh� eoaslroeNon, in�fallNioe for wirlsY. p�+�9. Ya huNn�, aw�r � wahr. !� sen to a�
n�
fiw luiWlaY �e�p�c�sr ior s�P�eah P�nohs foe fh� N�s.
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APP'LICATION FOR BUILDING PERMIT
CI7.'Y 4F FRIDLEi',
MINI�TESOTA
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LOCATION OF BUILDING
No, Street �a�t of Lot
.._...._,_...�
LOT �BLOCK� ATfDIT�ON OR SI7BDYVISION ,, r ��•.-��
Corner Lot`_Inside LaT Setback Side-+Y'ard
SEWER ELEVATION FOUNDATItiN ELEVATION .
Applicant attach to this form Two Certificates of Survey of Lot and proposed
1�uilding location drawn on these Certificates.
DESCRIPTION OF BUILDING °
To be used a�; -
Front Degt � fleight
Sq. Ft. Cu. Ft.
Frant Dept `�_Height`
Sq. Ft. Cu. Ft.
Type of Cou$tructioa �..c- o�• G�
��t ESt��tea co ti3
_r______
To be campleted
The undersigned hereby makes application for a permit for the work herein specified,
sgreeing to do a].2 work in strict accordance with the City of Fridley Ordia,ances
and rulinga oi the Department of Buildings, and hereby declares that sIl ti�e facts
and representations stated in this application are true an correct.
,---, . � i
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DA�_ �
{Schedule of Fee Costs can be found oa the ev�
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� P�►RT(AL R�1TE SC��i��3LE
GR]lYiT7 NIAPUt 14IR: Rl1Y'� ?OTAL.
ll:raace St:et2 � Ih2r! Work . . . . . . . =10.U0 i
iteptacement oi P1�rnace 6.� , O O
Rcpair� & Altcratioos---op to =504.00 • s {�p �,
Ftepairs dc A1t�ratfons each add. �500.04 . 3 W E
liLC2i. WARI�i AIlt
�lxrnace Shetl � Duct Work to ]i0,00� BT[T
elCtt sdd. A0,000 B'IV . . . . . . . . .
titpIacemcat of Flirnace
Rep�ira de Alierations--up to j500.A0
Repairs dc Alterations each add. :50Q.00
. . alo 0o t
3.W i
6.00 i
B.UO j�
3.00 =
STEAM or HOT IiVATER $7STEM
F�rr.ace Shell Sc Lines—tp 400 sa. !t. F.DR Steam �:0.40 �.
Fl:rnace Shell � Line----to 640 sq. it. EDR F;ot Water 20.00 E.
Each add 200 sq. ft. EnR Stesm �,t1ft ;
Each add. 320 sq. tt. EDR Hoi WaLer 3.00 ;�,,,, _
OIL SIIRliEA—to 3 gal per hour 6,Op S.._.,,�
over 3 ga1. per houc—See 1�'ee Schedule
GAS BU7RHER (up to 199.000 B?tn b.00 ; �.(�Ci
ovsr 19°�.000 A'!'[1 So� F« seludut�
GJ18 FITTING FEES: !(C RATE TOTAL
lst 3 Flxtures ___._ xE 200 t �"�b
AddiUonat Fixt� x ,� j__ _
Gas Range to 199.00d �f 6.Oa =
� ��o�a State Surcharge : .50
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r� x�a►rna� stsr� ' sa. p« s�b.a,�. J b. o C'�
v�i.Yttsc aYSraa�t �
�I.TtAA.TIOA$ t AEpltIlt� tOT�I. !S6 s a3 •s'O
aovas .
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D.p4. of �ld�s. Phoe� 88U-36�i0
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City Ot �idley: '
The undersigned hereby makes application tor a permft for the worf� t�ere€r
specified. agreeing to do al] work in strict accordance with the City Or�iinanc�=
and niling of 1he Departm�nt of Bvildings, az23 hereby declsr2s thgt aIt thc fac�
and reUresentativns stalyd in ihis applicatioA sre true and correet.
Fl�idley, Minn /vQ �✓• °� / 1� 7� I
,
(?wner _ ����� � /j�� �/S ��' ��
Kind �f Building �✓ ��� � �/� F
�Jse� ac , /7CJ fJ S �
To be compieted about. �FC� °�
Estimated Cosr, 3— L v� OG, G O
Otd—New. Building Permit No. _.�__ P�rmit No.
I3�CRIP'lIOA OF W03Rg
HEATiNG or POWER Ft.ANTS--�team� Hot Water, Warm Air—No
3'rade Name %�FIV �� Gr O/� Size Ne-��s/�i` / G1 Ei
Capacity l'�.O p��'____ 3q. �'t. E.D.A BTU H.F
Tota2 Connected Losd Isind ot !'uel ��%
BURNF.A — 15rade Nam4• Siu No
Gpadt7r S4. !'t. E.D R- 8'I'ZT �
(MMA�1[f�C�YER�
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1
sua�ecT PER
c�ty of Fridley - 17 7 0 8
AT THE TOP OF THE TWINS B U I L D I N G P E R M I T �
r
; � REC .
� ' COMMUNITY DEVELOPMENT DIV. � ���j
� � ti: ----�-
r � � PROTECTIVE INSPECTION SEC.
1 i ;� r���1 CITY HALL FfiIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED 8V
� ""�: `.J
612-571-3450 910-F15 9/10/84 / /
�os AooRess 711 IEennaston Drive N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. � 3 � Brookvi ew Terrace SHEET
2 PROPERTY OWNER MAI� AODRESS ZIP PHONE
Jerry Chlebeck same
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO.
4 ARCHITECT OR DESIGNER MAIL ADDFiESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDINCa
residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION �] REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
re r00 f
9 CHANGE OF USE FROM TO
STIPULATIONS
1. Can be second roof, but not third
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATEPERMITSARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, fiber �aSS
VENTILATING OF AIR CONDITIONING. 9
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WOfiK IS SUSPENDED OR ABANDONED FOFi A PEfiIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APP�ICATION STAILS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PFOVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED �� 500. OO • 75
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 25.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
25.75
� SIGNATURE OF CON'RACTO OR AU HOR ED AGENT IDATEI E� PROPEPLY VAUDATED THIS IS YOU PERMIT
����%�P �'� 9��J� �
Si ATUREO OWNEAIIFOWNERBUILDERI IDATEI BLDG INSP DATE
�
CI7Y 0� FRIOLEY
Effective Aug. 1, 1981
APPLIC/17I�'d FOR P,l:SIDLiJTIP.i_ [3UILDIiIG PEfZ'�TTS
(tde►•r, Alter.�tions, /1ddiLions, or Rcpairs)
t , .
01•�I�ER: ��e �2.tz-y C�/c �� � i; QUILDER: �
ADDRESS: i � : �e �n�AS� .. �.� ADDRCSS:
7EL n0: ..�' 7 �-- �S�_ TEL ��20:
ST1iI�T NO: � ��
Consl:ruction Location
s2�rtE�T: I�C'e �- .�. a c� j- b�t,.
i.o��: �� sLOac: ,i__[___ �nnimzoN: C�i�b�kv<<�. � ��,� �-�c.
Corner Lot: Insicie Lot: Setback: Sideyards:
Ap�licant attach to tliis form two Certificates o£ Survey of lot and
prop�sed building location drawn on certificates to scale.
DESCRIPTIO�d OF COFlST��JCTIOPJ
��e � P� d`� rront: Depth : Height:
Square Feet: C�ibic Fcet:
Front:
Depth: Height:
Squar.e� Feet: Cubic I'eet: _
ou
Type of Construction : �( g C12 �j �� r S Est-imaL•ed Cost: $ �S� �°
T
Rb Be Oor,�pleted: � W� S.
Alt. A Alt. B '
Proposed Drive�•�ay Width If New Openinq Is Desised: $� $
S�� R�VERiE SID� OF SHEET �
1Sie undersianed hereby ma}:e� applicaticn for a permit fcr the t:nrk herein specified,
agreeing to c� ,all work in strict accordance 4�ith the City of I'ridley Ordinances and
rulings of the Deplrtmei�t. of Buildi.ngs, and hereby declares that all the facL-s and
rcpzesentations stated :n this «pplic�tion are true and correct.
D: TE: `T�LQ SIGNATUF•c^.: ..�-�--�
Stipulai:ions :
a `��� ��`'�-
��se
� �S � 5
1 v �
� . FsU1 LDIi�lG i'C(2111T FE:t= Sc:ti�r_nu�c '4 _ .
;1.:C'!•iOl7 2. '1'li� In�:j�ectar. of 13uilc'.ii�cj ;:cliri].1, hnf:a�:r, i.�,sui»g Z�cnnit;; tor Ll�c cr .•L-
uf ����y l�u�.].�l.�n�� ar :�t:ruct:urc, or. fo� aiiy ac1cl�.t��.c�n !:o auy er.i;,L-�.»� }�uilcling �- stzuctur.e,
. ci�' i:c>r tuyy �z�.L•eraCion or. r.cl,axr.s Lo •any c::i. .L-in�! 1�ui.l.di,�i�� or sL•�ucturc, u��� aT�pli.cat.i.or�
tlicr.:ior.c, requirc U�� pr,ymc�►L )�y tl�c aX�pl.icant: f�z- sucli ��cr.r�it oS fecs - thc arn�unt
hcr�.in beJ.o�•� sc:L- for.Ui �uid in the �lannez hcrcin proviciccl L•o-t:S.t: .
}:):1•t CONS�PI;UCTTQIJ: Sing7.e l�ami;l.y llorr,es and Gar.ac{es: Y4.00/].,000 cuU'c feat.. .
I?LA:� Cit):Ct:: 25 percei,t: oi bui.laing pc�.-miL- iee.
UIt1V�1•IAY llL•'1�P.c:SSIOt:: (ConcrcL•c GZirb Strcets Only) ` �'
• A].tcrnat:e A: ltc�aoval and re��Iac�ment of ncrete cuzb and
quL-L•er only; Driveway �ridt plus 6 feet x$13. �0
1�1L•crnatc II: }t�moval and rep�acemcnt f concrete curbland
. gutter anci inst�ll a 3 o�t. wide approach �ait:h �'
' .. 6 inch depth; Drivc�� width �plus G feet x$15.75
Ibr the purl�ose of co:nputi.ng fees for_ buildinq mits, L•he cubica� coi:tents of any
build�.ng or addition, is deter,:ni.ticd by multip.ly' �g L-he ground area covered irom a
, point sis: (G) inches belo•,a thc tloor ].ine of - e basemen� or ths cellar to tlic
average heights of thc �up�er sw-face or to t e average heigiit of the ro�f. �urf:ace
of the raazn gable of a pitched roof. �
Foz reFai.rs or a�terations to an existin structure, the fee shall be at the rAte
of $3.00 rer each five hundred dollars�($500.00) or fraction ':hereof in the cost
of all proposed wor.k. � . , '
In �no case sha;.l the fce cliarged f any pennit as set iorth xn Section 2 be less
t2ian $7. SO plus $. 50 �tate surclia ge. •
NOTE: Permits :or cons,
of application to a].locv
construction site.
A Certificate of Survg ,� of the lot, shoc,�ing the location of the foundation once it
has l�een cons�nicted�will be required Uef_ore proceedi�zg with thc iraming.
� RT i F�.CAiE OF OC� UPAt��Cl' � �
0
:ion will be issued a minim� ai 24 hours from i.l�e time
proper review of tl�e proposed structure and oi the .
' ?+pplication for
u�e or accupan
said structur
bcen issued.
a Certificate oi Occu��ancy shall be madA ten (10) days prior to the
y oi any stiucture for �rhich a builciii�g permit l:as been issued; and
shall. s�ot be used or. occu�ied �:iitil a CertS.iicate ot' OccuPancy has
, '
• > � � •.
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, .
sue�ecT PfRM1T NO.
City of Fridley 2 8 4 6 0
AT THE TOP OF THE TWINS B U I L D I N� P E R M i T
r
; � RECEIPT NO.
� •
COMMUNITY DEVEIOPMENT D�V. ����
r � y � PR07ECTIVE INSPECTION SEC.
� _ �"'1 � CITY HA�L FRIDLE� SSIJ2 NUMBEN pEV D�TE v�GE OF �vvnOVEO 8�
�""'��� �'� 612-571-3450 9t0-F15
10/28/98 � �
!OB AODRESS
711 Kennaston Drive NE
t LEGAL �07 NO. BIOCK TRACT OR ADDITION SEE ATTACMED
oesca. 13 1 Brookview Terrace SNEET
2 PRO�ERTY OWNER MAIL ADORESS Z�P PMONE
Cind Carlson 571-8992
3 CONTRACTOR MAIL ADDRESS tIP PNONE LICENSE NO
Four Seasons Roofin & Rem. LLC 7930 Univ. Ave NE Fridle 55432 795-9410 20138780
4 ARCHITECT OR DESIGNER MAIL ApDRESS 21P PHONE UCENSE NO.
5 ENGINEER MAII AODiiESS 21P PHONE LICENSE NO
8 USE OF BLILDING
Residential
7 CLASS OF WORK
� NEW O ADDITION O AITERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRI9E WORK
Reroof house and arage (24 S) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TVPEOfCONST. OCCUPANCY GROUP OCCUPANCV�OAD
SEPARATE PERMITS ARE REOUIqEO FOF EIECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONOITIONING
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING SQ. FT CU fT.
AUTMORI2ED iS NOT GOMMENCED WITMIN 60 OAVS. Op IF CONSTqUCTION
OR WORK IS SUSPENOED OR ABANOONEO FOR A PERI00 OF I20 pAYS AT
ANV 71ME AFTER WORK IS COMMENCED. NO DWLG. UN17S OifSTREET PARKING
I HEfiEBV CERTIfV THA7 1 MAVE READ ANO EXAMINEO THIS APPLICATION STA��S GARAGES
AND KNOW TME SAME t0 BE TRUE AND CORRECT. A�L PROVISIONS OF LAWS VALUATION SURTAX
AND OROINANCES GOVERNING THIS TVPE OF WOFK WILL BE COMPLIED
WITM WMETMER SPECIf1ED HEpEIN Ofi NOT. 7ME GRANTING OF A PERMIT $2056 �I.O3
OOES NOT PRESUME TO GIVE AUTMOiiITY TO VIOIATE OF CANCEL 7ME pEqMIT fEE SAC CNAqGE
PROVISIONS OF ANV OTHER STATE OR �OCAI LAW REGULATING CON-
Tlp OR TNE P f.OfIMANCE Of CONSTRUCTION ]�}.%rj Fire SCi �2.�6
P�AN CHECK fEE T iAL FEE
�� �� � Zicens 5 0 $82. 84
S�GN4IUQE CON f.TOQ A�UTNOpIIEO�GENT iO�rE� E DR LV VALI ED THIS IS VOUp P RMIT
i
L J
S�GNatuaEOaOwaEp��FOWNEABU0.0EA� � •rE� B G �h5 ��iTE
.
NEW [ J
ADDN [ ] CITY OF FRIDLE�'
ALTER [] SINGLE FA1�III.Y Ai�1D DUPLEYES R-1 �vD R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: � � � �n �Q,S �� _____ _ __________
Legal Description: __,_ _
��
Owner Name & Address: �� �� CG�( S�ly] _
Contractor: �-r�� �r �c� sar,-�� �o��.,.�
Address: / Q 30 ��% 1� � U.P ,�s i
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Effec�i•��e li 1/98
���
U`� � �
�3
Te 1. ��--� g�-�_
�IN LICENSE #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction dra«-n on it to scale.
Length
Length
Length
DESCRIP'TION OF �IPROVE�iENT
:�
W idth
W idth
Width
Te 1. � �� ��1�
Height --- Sq. Ft. -- _--
Height Sq. Ft. ___
�igt/Ground Sq. Ft. ____
��t �.�� n�CG.. �.
Cons[ruction Type: Estimated Cost: � ���(O, ��_ _ _
(Fee Scnedule :.>n Back,-
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x S_ __� ____
DATE: ID� ��i'Cl8 APPLICANT: �- Tel. �f ��� �`�l�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge .
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$�.� Fee Schedule on Reverse Side
$ �.6ji .001 of Permit Valuation (1/lOth%a)
$ /, d $.50/$1,000 Valuation
$ , . $1000 per SAC Unit
$ ,-�> $5.00 (State Licensed Residential Contractors)
$ - Alt. "A" or Alt. "B" Above
$ ` ' $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [] Not Necessary [ J
$_L�.�.�-f�.