P - 42124�uilding
Ynspection�
763-572-3604
763-502-4977 FAX
TH[S A.PPLICANT
PROPERTY OWNEIZI
T�N'ANm
From: unknown Page: 1/1 Date: 10/6/2011 1:03:46 PM
BUILDIN�
RESIDENTIAL APPLICATION ��
C�TY QF FRIDLEX
�'OUR �MAf4 A1�AitF,SS
�QOWNER �CONTRACTOR
,.�, ���, �. �
PeiYnit No.
Received By:
bate Rec'd�
4VJ,\J�.4�ti4i.V.ec ���'i�5'.'
�YJ�MI�r,� C�r�r U� STATg i.tCEN'SC� Yk i�iAD C�Tt'C Nl1MB�17
'�4C7Mt STA'1`� C.YCBI�S�
,4NT) C�'1'�TCATE 0� ADDRSSS: ClTY --- 37.4'F'B�ZtP
YI�'SY1'�LAN'CB Pi�Ot�fE FA�LL
i�lt6i'�It'�'Y'�'Yp'E ' t7Sl�t��.BP�M!!i'Y/rl�1VCONfSTtL�CfION S1iZ1E
ia TWO PAMI4YINl�w CATaSTRUCTtON sTbRI&s
C7 BASSMBNT FiNLSH �( ROOF
�► nec�c o srnn�ro
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TitPE 0� "W�R'C�: Oi�W EiOM� CANS��CTION C7 ADp1TI�M
MAthPt'Ht+fANCEJIt�PAi& ❑ RflMODBLTNG
DESCRffi81NORIC BBLNG DONS:
S� OF IMPROVEM�Ni' �.ENOTH WIIP
00 �_ O HOUS� dN�.Y
MlMDBR pF S�LJARES "�l.��+� j� OUSH & GARAGS
� 2��rrACx�� aAw�o�
P'ROPLL�ED S1ZB: ❑ DSTACFIED (3ARAGE
PROPCISL�D HBIt�TT:
�
❑ Rtuminum
Q Otlser
�
IN BXfS'fING OPBP(II�IG
Ott FfJlt N�SW O�6N1N(
OPB't+itNG CHANGSS dc
'AL
Pl�a Review
Firc Surchargc
Surcharge
Licatss Suxcharge
SAC Cp►arge
Curb G�t Escrow
�rosibn Cwtu�ol
�ark �ee
Server Main Charge
�Sollii
Q 7kim
Q Faacie
QYca ONo L4CAT[ON Ol� WINi�UVYS
•�i3SCRr�� Sti6 0�
(i3SING TH� 199� U.B,C FEE SGHEDULE)
n trxa�r rtt,B
a or��n
AA3EMFNT RGMOdBLthla SUHMt'Pt
l. SxistingPloorPlaa
�. C+ropo6ed floor plbn
3. List of sm�clutal mtmben to be uud
FOR N&v1 CONsTRUCftON iNGJ.UP1t10 p�Cll,S,
AL1L11TC � 1d �� PA (`��EiFR Ct IRMiT-
!. Siw PfaNSutweq shotirnng 1f� �cistings9n�ctwea
end Ptoposed pioject.
2. 'f'wo sete vi ecosFaveii� �laaa
3. R.e�ergy CaicuEau�e
POR W 1NDti1A'S � PR01+1f3$ U-YALUB AND
MANUFACTUCtH ST[CK�� ON 1NlN�W.
/:�lti t �,
$ �' ). L� See �aek Page for Fee Schech►le
� 65°fo of Auilding Petmit Fee
S .d01 times Che total job valuation
S .00OS x PeJmit Waluatioia Minimum $5.00
$ $5.00 (State Licc�sed Resid�ntial Coiitrac#ors)
$ $2230 per SAC Unit {Pixns to MWCC for determination)
S R+6ft= ftx$25=$
$ $4�0 Conserv�tian Plan Review
� �ec �e€ermincd by �ngineering
$ i _ _ , Agreement neeesssry ( ) Nbn t�Cecossary ( )
�ts ts n�ar nr�cns�€�x Fox a�saa�a�r-xor v�an urn t[. ��tacssssa
Y l�ereby epply for a buItding permit end T ecirnowtedg+� that the infomiatinn abave is com;plete and �ceurate; t�tat the wurk will be in
conformance with the ordinanccs Gades 4 Ciry 4f Fridl�� and r�ith the Minnesofa Ca�CntCtion Codzs; tt�t I understand this is not a
pem►it but oMly an appli�a#io w� � t ai� war� is nat to start �vithout a permit on site; that the wdrk wiC1 bc 9n accottiance with the
approved plan in the easa of 1�6'�wv ui e� � iawr and approval of p�s. � anc
SIGNATURB OF ApPLCCANtT Y. Y.AM _ itiNT 1�CAAME i'��`L+�T ��� T?A7L �`