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R[:SI:DENTIAL APPLICATION
CITY Or FRIDLCY
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ni�i��t� , Plymouth, MN 55447
Lic # BC645090 Ph. 763/745-1400
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f�-`57NGL�: I'/�MII_Y/Nf:\�J CONSTRUC"I'ION
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l l'I'I� UF WIIJUU\�J'I'O ItG INti I AI.1.Lil) ------ __ NUMIif-_R 01= �NINDOWS _
ALL rrrs n�ir; KASI:D ON VALUA"f'ION, INCLUDING TI-l� COti l Vt� Lnlsll�t niv�� ivin � e,ic�n���:
LISING TH[; 1997 U.[3,C FEG SCI�IGDULG)
OTALJ013 VAl,UA7'ION � l� 7 S OCCUPANCY `I'l'f'1
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I'ermit Fee 9' --_`Q-(,� ''i See 13aci: Page for I�ce Schedulc
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I'lan Rcvie�v `h- _.__ 65°/, of [3uilding Permit l,ce
Fire Surchar�,e _�----- --- _ OOl times the tot�l job valiiation
�urchar�c .i; _ � ' _ .0005 x Pennit Valuation Minimum 5�5.00
I�icense Sinchar�.�c �_`{� � _�j�!' __ R5.00 (State Licensed Resi�lential ('onh�actors)
SAC Chart;e `f _ ___ $2230 per S/�C Unit (Plans lo M WCC for clelcrminalicin)
Curb Cut Escrow _-R -- _ {j -i 6 ft = _ -- (t x `{�25- 9:_
I�rosion Control 4� ----l-- :h154 Conservation Plan Revie�ti�
Parl: Pee `� _-----------.--- Pee Determined by Gn��,ineerin��
Se��,�er Main Ch.irs�,e ,i� ngreement necessary O Non Ne.cessarl' O
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"fo(al Dor h . V i� Malce chccl:s Ii��yable lo: Cify of rridlcy ----_-__ _AU:►ch Slijiulali��ns ___
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I;������y �����,ly (i�r a builclin�; p�rmi �ind I acl:nme�led�,e that ihe inform��lion above is completc. ancl accur.ile; Lh.il Uie �voil< ���ill be in
conf�innancc ���ith the orclinances and c des �f lhe Cily of Fridley ancl ���itlt the Minnesota CimsU-uction Codcs; tliat I uncicrsis:ind this is not a
�,ermi� hut cmly rin a�i�,licaticin 1or a ��erni ancJ worl: is not to start ���ilhotit �i permit c�n sife; Ihac tlic w��irl: �-vill be in ticcc�rclnnce with the.
,ip��rovcd F�lan in tlic case c�f all ���c�rl: ic requ e evie�v •inci approval c�f plans. ����� �_______I>n l l: _._7_( (.
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