P - 45786OB/ig1E011 1?:�5? FAS 812 824 6�72 C� of M- HUMAN RESOURGES
Building , BUILDINC
Ins�e�tions �ESII��NTIA,L APPLIC 4T�UN
7C3�572-3604 ��Ty p� ��LEY
763-502-4977 FA,� i ����,mm..r., ,., ��.,
ba�r� (t, -.�t i —
S1TE AIiDRE$$
TiiIS APPC.fCANT I�S:
PRO!',ERTY Q W IYE�!
TENANT
❑ OW�ER
-�
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CITY
(�oo2�oa5
Pennit No.;
Received $y:_��iV.�—
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SLISMIT A�QPY 4F gTATE LtCBN$'E # LEAD G�RT NCJM1�TBF,.R
Y�Uli �'a7'ATE �.xCENSE —
AND CERT1F(CATE OF ADFRESS: CITY� 5TA'!'b 7,lp
iTti5URA1�ICE ps�n�u� �...
PRUPERTY T1�PE
PERIV��''�" TYPE
46SCRISE WQRK BEIIvC
ROOF1NGt
Ni71�lBL�R bl'' SQUA�S
�r.ABAGES
FROPO$Ep S1;G6:
PROFQSED HEIGFiT:
�st�GL� FAMILY1N�w C4xs�'itUCrtax
❑ 7W0 FA�,�[LY/NEW �CC�NSTRUC'I'ION
0 BASEMEW'f 81NtSFt ❑ R40F
❑ UECK ❑ S!pING
❑'N�W HC7ME CONSTRUCTICJTi
❑ N(AINTENANCF1REPt17R
SIDINC
❑ viny� '
❑ Aluminum
I� Other
WlNOQW$
f�t EXI9TR?G OPENIN(�S�,rca QNo
OR FOR NEW OP�NINC�S�DE5CRI13E SIZL' dP
pPENiNQ CHAIYCiL3 & , e .
AL.L .FE�6 ARE
VALUA
F'lart Reviaw
Fire SwrchaCge
9urchar�e
License Sura#�rge
SAC Charge
Curb Cut Escrow
F,rosion CanLrol
Park Fe¢
Sewer Mair� C�arge
❑ /•1DDITIC?AI
�1�t,P,Nati.DELING
❑ HOUSE ONLY
J HOtJSE & G.4l2Afi�
❑ .a�rT.aCH�D G�1tAQE
C] UETACI�iLLU CARAt;F,
t7Satrit
❑ Trim
� �:�cia
LOGAilt�lkiO� WQ+TppWS
W1TV1?OW5
Tk�E 1997 U.B.0 FEE �CHEUUL�j
❑ DAAIH T'fi�
C] C�'fH.ER
FT
�ASI�MENT RF.MpDELTNa SU$MI'I'•
1. Existing Plaor Fylar�
2. Praposed floa� plan
3, List ofsvuctur�l r�n,bcrs ro be used
H'OR NEW CONSTRUCTION [NCLUDIPIQ DLCKS,
ADniTI't7NS. �c poacr-rr•.ys c�?g!�rr.
1, Site Pl:�n/5un�ey ahowipg m� �Sti�g struct;,res
und propo9eA project.
2. Twa sots of wnslruclion plpna
3. Lr�rgy Calcufoticx�
PGR WINDQVI�S —PR�JVIDE U-VALUH AND
MANUFACTUR� ST[CK�it pN WII3pOW.
AND MAT�RI A.I.S:
� Q�CUPAIVCY TYPE
� See Back Fage far Fae Schedule
$ 65% of Building Ptrmet Fee
� � .OQI times Ch� tatal job vaivaiion
�. 1��, �.000� x perm;t valuation Min'srnum �S.OU
$ $5.00 {Stste Lice��sed Residentizl Contr�ct�s)
� $22�0 per SAC unit (Pl�ns to M�IC� far �cr�ninataon)
� ft+bf�= ftx$25=$
� $�45D �onservation Plan Revlew
$ F�c Detenmined bv Cngittetring
� --�-�-�-- A,�nant necassary ( ) Non 1�Tecessary � �
$_. t 1�) ��— M9ke ch�ks aavable to: Citv of �'ridlev Attee
rHlS IS AN APPLICATION I�C7R A PFRTiTi'�NUT uAi.ID 1:llv"fIL PROGE5SED
A�.ereby apply for a buildin� �permit �nd I acla�.owledge that the inform�tiota al�ve ls complete and accurate; thst the work will he in
confornnance with the ordinances and codas e+f the Gitiy af Fridley and with the Mirnac:�ata Coir�struction Cod�s; that I unders*and ttiis is not a
permit bu.t only at� epplic2ttion for � p�rmit and wdrk i5 not to stsrt with�ut � permit oq site; thst the work wiIl L+e i� �coord �oe with the
appraved plan in the case o�' wark wt�ic equire� rev' w and appzoval vf p�.�, �i �� n f,�, ��-� �ATE � C���f /
Si��NA'fuRF C1F AJ'PL[CANT PR1NT Nlu'+� i� t2
APPR4VAL INSFLCTOR SIGN "f RF,
., D I G d CC A7 /lTC . Q L'�D A ��A "1"�L7 bcv n rtr�r•ic �♦ cf �c n orti � � r rs r� r� r-inrs �nr. r n rnn�n r.Y wry�.,.�...�. .. . y�.. ...� ... ..�.. .. """'� __' .