P - 44835Building BUILDING Permit No.: l
Inspections �tE�ID�NTIAL A�PLICATION Received By:
763-572-36U4 CITY OF FRIDLEY Dat��t:�, � �i :
DA� llf 08/2010 YOLTRE-NTAILADDRE35 ��therd�w�ndovru�orldtnn.com
si�nDbt�ss 5626 N Innsbrook Ct .
TEIIS APPLICANT IS: 0 flWNER �CdNTRACTOR
PROPERTY OWNtER! �A�: Paul Laxson
TENANT �D�ss: same as site crrY sTa� z�
PHONE:
CONTRACTOR N,�: r ' 1 t r'
SUBA+IlT A COPY OF STATE LICENSE ;V BC - 2 03 5 5 84 7 �p Dq� � 3 12
YOURSTATELICENSE nnn�ss: 2211 1 t ve �� North S� STATE zu� 551�9
WITH AI'PLICATTON pHONE 6 51- 7 7 0- 9315 F� 6 51- 7 7 0- 04 95
PROPERTY TYPE 0 SINGLE FAMILYlNEW CONSTRUCTION SIZE
L'� TWO FAMII.Y/NEW CONSTRUCTION STORIES
PERMIT TIiPE ❑ ADDI'TION ❑ �nxAG�rs�v ❑ wnlnows
❑ BASEMENT FIldtSH O ROOF ❑ DRAIN TILE
❑ DECK ❑ SiDING ❑ OTf�R
� SWiMhllNG POOL
TYPE OF WORK: ❑ �v ❑ Annrrtox
t] MAIIiTEiiAT3CEtRBPAIR i3 REMODELI23t'r
DESCRIBEW4RKB�INGDONE: Replacing b windows, existing openings
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT . F�
$�� � HOUSE ONLY
NUMBER OF SQUARFS ❑ HOUSE 8c GARACiE i3ASEMENT REMO��LING SUBMIT:
t. Exisdag Ftaor Ptan
Sit$BA�o� � ATTACFIED GARAGE 2, proppyad floor plan
PROPOSED SIZE: ❑ DETACi�D t3ARAOE 3. L4stoie�uabualeeembezsto6eus�ad
PROFOSED f�EttGfPf:
�� FOR NEW GONSTRUCTION INCLUDING bECKS,
❑ Vitryl C]Soffit AUDiTIONS_ & Pl?RCHES SIiBMiT:
❑ Alwninum 0 Trim 1. Site PIaNSurvry shawin$ the existing strucdues
❑ Other ❑ Fascia and ProP� P%i�
2. Two sets of r,�structid� plans
WINDOW3 3. EnergyCala�
Ild EXISTiN(i OPENiNC3S OYes Oido LOCATION OF WINDOWS
OR FOR NEW OPENiNG5-DESCRIBE SIZE OF
or�cC�v�ES � 6
TYPE Ofi WINDOW'fQ BE LKSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ODi YALUATION, IIYCLUDING THE COST OF L.ABOR AND MATERIALS:
�
Permit Fee
Pian Review
Fire Surcharge
Surcharge
License Surcharge
SAC Cltarge
Curb Ctrt Escrow
Erosion Con1=ol
Park Fee
Sewer Main Charge
Total Due
$
$
$
{USING TA� 199"7 U.B.0 FEE SCHEDULE}
iN S 3 3 5 2 OCCUPANC'
See Back Page for Fee Schedule
65°l0 of Buitding Petmit Fee
.�1 times the total job valustian
.0005 x Permit Valuarion M'inimum 5.50
�S.OU (State Licensed Residential Contractors)
$1b7S per SAC Ur�it {Plaats to MWCC €or �eterauaation)
ft+6ft= ftxS22=S
$450 Conservation Plan Review
Fa Determined by Enginaering
Agroement necessary ( ) Non Necessary ( }
Make cliecks aavabie to: Citv of Fridler Aitac4
TfIIS IS AN APPLICAT[ON FOR A PERMIT NOT VALID iJNT1L PROGESSED
I heret'►Y �PP�3' far a building permit and I�tcnowledge that �e information above is complete and accurate; that the work will be in
conformance with the ordinances artd codes of the City of Fritlley aad with the Minnesota Consiavetion Codes; that I und�rstand this is not a
permit but only aa application for a permit and work is nar to start without a permit; titat the work will be in accrordance with the aggroved
p2an in the case of all work which es review and approv� oi plans.
SICiNATURE OF APPLICANT \!��� / 0►' PRINT NAME E S'tYl@ r DdYll DATE 11 � 0 8� 2 O 10