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iTE ADDRESS � � 7
'HIS APPLICANT IS:
�ROt ERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
Y.QTJR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
❑ OWIIER C3�OI�ITRACTOR
�
.�D�ss: i 7� z rv ✓ a it u uc_�c:u
PHONE: � � 3 S 7 I- 8 3 3 S
— __ ---.... -- --
Pella Windows & Doors
N`��— 15300- 25th Avenue N.- Suite 100
STATELIC P1�IT10Ut11, MN 55447
aDDxESS: �63/ 745-1400
PHONE License# 20165884
s�LE
❑ TWO FA �
Permit No.:
Received By:
e�i s c�e��t't�� o�1rs. �on'1
I' I
•"•z� 55 �l 3�
oc�: c� _F/�(�r t o A�
S? 3 4S • L o y7
CITY STATE_ZIP,
QADDITION ❑ GAR.AGE/SHED Ci'aPtNDOWS
❑ BASEMENT FINJSH ❑ ROOF ❑ DRAIN TILE
❑ DECK O SIDING ❑ OTHER
❑ SWINIMING POOL
TYPE OF WORK: I � ��'�'
)ESCRIBE WORK BEING DONE:
IZE OF IMPROVEMENT
.DOFING
RJMBER OF SQUARES _
�A.RAGES
ROPOSED SIZE:
ROPOSED HEIGHT:
LDING
1 Vinyl
] Aiuminum
I Other
VCE/REPAIlt ❑ REMODELiNG
w�ndo�r ��p au �.o� i� o�r� s�n� oP�n.n
LENGTH
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GAR.AGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
'INDOWS
d EXISTING OPEN]NGS f9i es ONo IACATION OF WINDOWS
R FOR NEW OP£11INGS-DESCRIBE SIZE OF
HEIGHT
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of siructural members to be used
Ft.
FOR NEW CONSTRUCTION 1NCLUDING DECKS,
ADDITIONS. & PORCHES SiJBMIT:
1. Site Ptan/Survey showing the ezisting structures
and proposed project
2. Two sets of construction plans
3. Energy Calculations
PENING CHANGES & I
YPE OF WIIIDOW TO BE INSTALLED ra �� ���► �S NUMBER OF WINDOWS �
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING T„�iE 1997 U.S.0 FEE SCHEDULE)
. TOTAL JOB VALUATION S t� u°� OCCUPANCY TYPE
�rmit Fee $ / 5 3. � See Back Page for Fee Schedule
lan Review $ 65% of Building Permit Fee
urcharge $ y. �° (.0005) times the total job valuation — Minimum $.50
ire Surcharge $ � n° .001 x Permit Valuation (1/10%)
icense Surcharge $ . O O $5.00 (State Licensed Residential Contractors)
AC Charge $ $1450 per SAC Unit (Plans to MWCC for determination)
urb Cut Escrow $ ft+ 6 ft= ft x$20 =$
��sion Control $ $450 Conservation Plan Review
3zk Fee $ Fee Determined by Engineering
;wer Main Charge $ Agreement necessary () Non Necessary ()
otal Due $ 7 0, �? S� Make checks navabie to: Citv of Fridlev Attac6
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
hereby apply for a building permit and I aclrnowledge that the information above is complete and accurate; that the work will be in
�nformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
:rmit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
an in the case of all work which requires rev and approval of plans.
JNATURE OF APPLICAN't� / � PRINT NAME ` , � ` �� �� n � DATE v �� ( ( �