P - 44208� qa.o 1
Buil�.ing
I�sp�cti ons
� 763-s�z-��a�
BUILDING
RESIDE�TTIAY. AP�LICATIUN
CITY OF �'RID�.EY_
p�ermi� No.
__.
f]A1.F__-� - a a- r �Q- � YC)LJR E•MA[L t1DDRh:SS
�,— —
SI7'E:AllUI�ESS���_ /v• _,.$�lhyl�t' �55 _, _... �—
TH15 APPLI(:ANT �s� ❑ oWNr.R �C;C}NTi2AGl'"c)R N �� � .-
-i�ROrEK'rY c�wr�w Nanag: Ka-� een L a rso�__G ... ... ..
TENANT /aDDRF"•SS:.. ICo3"�Sr N•�ehnef ,r���..._ Fr�,.d�...•-
PFaON�: �Y+_ ,� �X-� qNS�i
GONTRACTUR
'itl�MfTA COPY C?t�
YpllR STATL LICk;NSL
W i'!ff APPLIC:ATJC)N
PROP�RTY TYPE
l�LttMIT TYPE
Tri}E oF woR�c:
xnn�ts:�' o W
�'A'1'E LiCENSF's �_ ,�
A„��s5:990 �o
��
❑ �asF,�a�v�r rn��sH
la DGCK
UESCRiB� WUKK S�iNCr
SIZE U11 iMPROV�MLNT
NUML�R OF S(,1UARIi5 �,
GAR�GF�
PROf �SED SIZkS,._ .
YRpPP]Skil) itEICiH'1': „
.1�1)rniG
❑ �'iiryt
Cl Al�uum
❑ Clch�t' _ .
���
(i()P�NINti5 �Ycs ❑No
('�i FOR N�VU Ol'kiNiNGS-DF:SCRIBk: SIZC 4F
OP}31�lNG GHANGES &
TypE pg 1A+tNDOW TO BEi f13ST,Ai,1,kA7
� `l .S �xr nA'1'� � S -- 3 ! — ! �
.. -
�Sie //�___ _cirY E
rnx �51 05 1?�L
RUCf[(lN S!!E,- - —
c•nor� s�Rir:s�,_„�
p GwRnvr-.JSxEb � r wnaa�wS
❑ ROpF CI DRAfN TfIE
❑ SIDlNti ❑ U'I'HEK
.
L�;NGTii
p 11lO�1S� dt I]ARA(il:
CJ A7'�fACHEUf.;aRACi�
a ta�r.�ct�Fr� cnxAC�r:
DS�tI�t
❑ 'T�i�
d ruseia
R� t0.�e ,�
�. � 2�Ci 5-}� i �.
�W[DT'kl ii�F..tG;
BASE�M4
!. Existin�c 1
1, Fropcmexl
3. List cyf str
F(}R NLVV COTTSTI
�����
i. Sita Plam
ATfc�t UF WINI]c)WS �r0o
[,ix,f � _ch e��!�'� _�
F.T+
F'EES ARE BASTD 0�1 VALUA'
(USING
AL
Permit Fee
Plan it�vie�v
Fire Surc:hsrge
Surdiatge
Lieet�se 5ureharg�
SAG Charge
Curb Cut �cmw
Erosion Control
ParL T�ee
Se�er Main Charbe
vA�,u�
, INCLUDINC Tl-�L COS7 OF
1997 U.S,C FL�E SCHEDULE}
�q. 0 O OCCUPANC'
2. '11NO :�ts
3. �.nnrgy C
a
R AND MATI
�'m"�''��� -— See 9ack Page for Fee Scneawe
'$ 6iYo of Buildin� Fennit Fee
�"—' ^.p01 times the r�tal jub valu�tion
� .OU05 x Permit Vaivatinn Minimuni �.50
�'� �v $5.04 {St�te Lic�,nsed Residential Con�aators)
� �$�G75 per SAC Llnit (P1ans tc� MHVCC for c%tern
� fi+6fl•�_�_ftx�2t =�_._
$ . $450 Gonservation Plau �Leview
�' � F�ee petermined by Enginearin�
$ _ A�,�'eement nea�ssary ( ) N� Necessary ( )
- ..,.-• -� a..:,u,�.
1 v�a1 l/ue . ,
7'HlS f5 AN APPt.iLATIt)N PUK A P�kMI'I-NOT VALiI] UN'f'iL PftC1CG55ED
1 hereby applY for a building perntit and [ acknav��ledg� ttsat tl�e inforimation abavt is oomplete and aacun
ca�fornrniaanc� with tiie ordinances �sd eode� of the City o1' Frridley and H i1h t�►e Mirn►esot$ C.onstruction Cades;
■
per.�it but only aa �pplication for a permit mnd work is not ta stut withcwt a permit; tbat thc worlc wiil be m;
pla„n 'sn the ca� of af! wark w ich requires re iew d apprc�val nf plans. �
pV'P NAML ��Sc�►rn i Q S� rt�a��
SIC�fAI'L�' OP APPLI�:AN'1' , �—• �_
tid Wd90:b0 z00Z £Z '��0
LB�TtiZ5�9L: 'ON XH�
�y:
.
, �,� �
ATE ��P ���y3a
i
� 55ia1
FX
tnnribcrs to;ba nsed
bo=
)7� 11,f(;I.lJ�1Nt31)F�CxL3,
sho�l�i� existing�ruau�cs
Ja�•
�rttction nl�ats
�
that the work vf�f11 he in
I understand tbis is not a
rdance wit4� thd apprqved
,��-I O
hajpia� .fo;, ��?�: t�2i�