P - 62693.
Building
Inspections
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'I7{IS APPLICANT 2S: ,
PROPERTY OWNERi
TENANT
C�NTFtACTOR
SUSMI'I' A COPY OF
YOUR STA'i'E L[C�N3E
WI'1'H APPLiCATIi}N
BUILDIN�
R�SIDENTIAI, APPLICATIt��
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iNAME: ` `�
ADDR�SS:
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NAME:
STATE LtC�hISE k
ADDRESS:
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192Q Caunty Road "C" West
Rvseville, MN 55,113
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65Z-264-4777
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Fire 3urc}�rge
Surcharge
L'ucense Swchmge
sac cn�
Curb Cut E.scrow
Erosion Gontcal
Pat'tc Fee
Sewer Main �harge
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3'i"ATE 2[P
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3. Exista�g FtoatPi�t
3. L�ist af�sau� �bas u� 6e �eQ
FOR N�'W' CONST'RtIGTIUN INCLUDINC3 nrIICKS, .
Avo�s�oivs � �aet�FS susiutr:
L Sice P�nl$tuvCy �114wi� d►e e�tisliqg ahucture
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2. Two ser4 olvonatn�Hon plans
3. Ensrgy Catcel�tions
LARQit Al"�ID
1997 U.BrC
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65% Of Bui}ding P�sni# Fa�
.(101 times the tortal jab vatuaticm
.0445 x P�rmit ifaluatia�s l�r[inimum $.SO
�5.40 (State Licens�i Rcsidential Casidactors)
S 1558 per SAC Unit (Plans ta MWCC tnr detanninationj
�t+6f�� tix$2L�S
�450 Conserva#ian �'lan Rtvi�w
Fee Dettimined by Enginaering
Agreeme�t neces�y { ) 1+ton Ne�xssary ( )
TkiLS IS AN eSRPLIGA'CION FOR A P�Riui[T-1+TQ[' VALID t]NTIL PItOCESSF,i�
I hereby apply f�r a huilding permit and I�ccimawletl�e ti�at the informatian above is complete and a�ceiu�ate; th�t the wark wiil ba u
c�:forrnance with d�e orsimaacxs and cocies of the City uf Fridley ar�d wiih tise Minnesota Camseraatian Co�3ea; ds�t I u�iciarstaitd dua is not r
p�rmii 6�t �ly an applicatian fcrr a permit �d wc� is not to start v�+ithout a perm�t; that the work wi�i bes in ecet�rdat�oe with t� s�tp�vva
gl� in the case af all vuorlc Mv ich requi eview and approval of pfar�.
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