P - 39390From: unknown Page: 1I3 Date: 9/8/2011 9:45:00 PM
Build��g BU�IfDIN�
zx�sp�ctior�s R�SIDE�T'���4L APP��CAT�Cl�T
�6�-s�2-�604 CIT�.' tJk' k'�IDI..EX
763-542-4977 F,A� EFFEC7IVE 1�1-2011
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SITE ADDR£55 %�d •� � �/ ,S S e 5s .��,r� f r J��/^� d't' �� —
THJS AjP�'LtCA1VI' IS: L] OWN�R �ICONT,RACTOR
'�'�NANT
CONTRAC'X`QR
SU�MIT A CO�lf 0�
XOUR STATE �,IC�NSE
,ANA CER"I�IGA,"T� 0�'
INSURANC�
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TYPE OF'WORK:
DESCRIBE WORK B�tNG C
�
ST.ATE LiCENSE S
'Ss, a�,' S� /�E
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Pc-rot,t� �/a � f�i —i � r �
�WGLE FAIv�11�X/�T�VH GONSx�UCTIDIV
p'CWp�AbQLY/NEW CONSTRUCTION
❑ BASEM�I� FINISH �CkOOP
C1 D�CK CI S1pING
� SW�Iv��v11T1G POOL
❑ NEW HOI++�� CON57RUCTION O AD��'f�QAi
O MAiNT�NA�TCkJKEPAJR �'R�M017LLING
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SID
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❑ AlutAinum
Q diher
WINOOWS
IN L7a3TfNG 0�£NINGS OYes �No
QR FOR NEw OFENtNGS-DESCRIBE SLZE U�'
QPENtiNG CkIANG�S &
ALY.
TOTA�. J(3B V.
Plaxt �teview
Fire Surcharge
Surcharge
�.ice�se Surcharge
SAC Gharge
Cc►rb CuE Escrow
�cvsion Contro!
Park Fee
Sewer �ain Chsrge
❑ i�0US60NLY
�'F101ISE & GARAGB
� A'fTAC�D GARAGE
� DETACHFD GARAGE
❑$piFt
❑ T7itt1
D �ascia
LOCATtON OF wTNAOwS
CER7
�ermit 1vo.:;JQILL"
Received By: 1 yc
n�t���� � � �
CITY_ OIt��"'� STA,
0 ARA1N 7TLE
❑ OTHER
ON VALUA'�'�O�i, x1VC�.UDING TH]E CQS'[' QF
}(USINC� TIiE 1997 U.B.�C k�� S�X#�DUL�)
1. �xisting Floo� Plen
2. Proposod kloor plaz�
3. ListoFsVUCturalmE
FOli NEW
1. Site l'IaNS�rv�Y showi
and proposed pYOjCCt.
Z. 'x'w0 Sa1S Gf constructit
3. En¢rgy Calculat+oaS
FOR W1NDt�WS – PitOV1AE U-
1vtANiJFAGTURE STICKE�t �N
.TERIALS:
$ `�; � . �.y� $ee Back Page for �'ee Schedule
$ 65% of Building Pe�'lnit �ee
$'�'� .001 times the tvtal job valuatio�z
$ i�G� 0005 x Fermit Vaivation Minimum $S.QO
$ �,r t"� $5.00 (State Licensed Reszde�tial Contractors)
$ $2230 per SAC Unit (Plans to 1VxWGC for determination)
� ft+6ft��ftx$35�$�
$ $454 Consen+ation Plata 1�eview
$ Fee �etermioed by Engineeriictg
� -- Agreeme�t �ecessary ( ) Non� Nec�ss�arY ( )
THIS IS AN A.PPLICAT�ON �pA A�ERMLT-I�iOT Vq�,Ip UNTIL PR4CES$ETa
i hereby apply foX a buatding pesmit and I ack�towledge that the information above is complete e�nd accu�ate; that 1
conformaatce wlth the ardinatxces atld codes of the City of Fridley ar►d with t}�e Minnesots Canstzuction Codes; that I uz�c
perrnit but only an apptication for a pe�xc and woxk is t�ot to start without e pe�it an site; Chat the wqrk wi11 be in +
apptoved p1ar3 in the case o;Fa1� wor hich re ' es rev d ap�xt+val of pi s. , ,-- � r,�,,,
SiGNArUREOFAPPI.�CANT����l PRTNTNAME ll�el �4k�loC4t�' DATE
� �I
–r—' �'�
o �r
aL
to be used
[1ATNG DECKS,
L
t�e existing sauccuns
�ians
�i.,[3E AN�?
work vv�itl be in
rand this is not a
�rdance with thE
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