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P - 59365�L��IU���� II1S1��C110115 7�i3-572-36O4 ��,�-so2-4<��� ��nx �u��iv�iv� RI;�I:DENTIAL APPLICATION CITY UF FRIDLEY �.r-rcc'rivr: i-i-?oi i i'l;llllil IVU.: �����-��iJ�-- Rcccivccl I�y: � fi Y_ _. � �<<<�E�"���� P�-� -�—�1-�2 r�:a� r__ _�i�� S l!� __ _____ --___ vc�ua r-Maii_ n�iaar ss _��0 df S�[ lel�if' o A� S. ! n M - -�— --- ---. _--- srrl:. ni>nrr.�� __ -- ---G S_3_iF— � Q �' l! �/-- %�/' l Y__G_ . — ----- ---- --._ fHl.ti �I'PLI(:�N"I IS ❑ C)\��NER I�,('ONTRAC'fOR r��zo�'GR7Y OWNi;R/ TrNANT coNTanc•ro�i s� n3Mrr n cc�r�v c�►� �����_�rz ti�rn�ri� i_�cr:NSr� nNi� c�rr � n ic'n�rr <�r INSURnN('i: ►�aorra•rv �rvrr, r��:rzn���r ��vrr. Tvr�� or wo�t�c: NnMi.. ������t���� G���l__ b�C! --_�� �ll'� ��� ��,���: 7� 3�� ?�� _S ���-- �J�M�.- Pellallorthland s rn�i i=: i 15300 25th Ave N. Ste 100 �i�i��,�:, Plymouth, MN 55447 �,� iuN�: Lic # BC645090 Ph. 763/745-1400 �:.�a L�'SINGLf? 1=nMII.Y/NE\�✓ CONSTRUC'fION SIZ1: ❑ r���o t nn•�ii_viNr.w coNS�rrzuc-rioN sror,ii_s l7 A[)I)I'I'iON ❑ C�ARnGE:/SFII_D — ❑ IiASI�M[:N"I� f INltil I ❑ ROOP ❑ DI?CK ❑ SIUINCi l� tiWIMMINCi PUOI. ___ __--- -- ------- -------------- --- ❑ NI:\�� FI0�41� CONS"TRUC'1'ION ❑ �Df:)I"fION �1hIN'fI:N/�NCG/R1=PAIR O RGMODI�LINCi � • �-�-�, -- - . . ----- ---- ---- -- �1��-i___ _----tirnr��.i.n�SS'V32_ ---------_._ ---------� r•_nu cr•.irr n�un�r;i:a__---N-- cn�v I>6SC'RI(il' V�JC1RK RGINC� DONii: ti17F ( )1= IAAI'ROVLMt�N�I� ROOFING r�i �Mi3rii � �r ti� �i ini<i:s �::�un�:i�:s ('Rnl'O.�fif) SI%.li I'R( )I'USI�;I) I II� I( il I'I' till>IN(_ [.] \/in1'I ❑ Alunnnuni ❑ ( iUiei _ - _ _ O Ii0USl3 C)NL}, O 11OI I.SL• �c c�nitnc�i. ❑ nrrnc:iii:i�c�nicnc�i:. �� r�rrnc:iit:i>anitnc�i. C]Sol�fit Ll "frim ❑ Pasciri WIDTI i �a�iN�_�c�wti ❑ URA IN 'I'I L-I:: ❑ O"1�1 If'IL �.�t�L_C1t(_l�. FII'I(.i�l.l . �o t �n . � ��rn rr z.ii� c�;� 9 � ti(1 P'f I3�SI:M1?N I' I:I'.M(11)I?I,ING SU13M1'I , _. _ __ _____ . . I I:sitilin�, I'Irni� I'Ism 2 I'm�i�iscil Iluix ��I�in � I.isl nf slruc(nr�l mrnihcrs lii hc ntir�l I( �I: NI'.bV C'ON.ti'fRIIC'I'ION IN('I.I�I)INI� I)I;('I�ti, nL)I)I i lON,S _�l I'(.)I'._�'lll ti tiUltMl'I.'; I tiile I'I�n/Survey sho���in�, Ihe c.�islm,� siruclurcti �nd rro�ioseci project. 2 I'�vci scls ufconslruc:tiun �il;ins �11NUON,ti � GnerZ.Y < �ilc�il alions IN E?�ISI'�ING l)i'I;NIN(�ti C�s ❑Nn I.UC'A�I'ION Of� VJINDOVJS PUR WINL)O\A�S f'ROVIDG U-VALUI� �NI) tiR F(.>It N�W OPI�NINC�ti-I)FSCftllil: �;iri: cii- Larndr�±n+�r��.bs��f.��ef��h�j.Jir.A�, �i�ii/M MnNUI �C'fUI:L S1'IChI?R ON \��INI)OW �)f'GIJINCi CI IANGI�S R: �' � N � �� % / ` fl'PL (1F WINI)UW 'I'(� 13f. INS I nI.I.L U COiIRltqf' j,__ _ NI1MI.iER OP WINDOWS ._. -- -------- ----- ------ _ ---.. ALL FEEti ARG f3ASI?D ON VALUA`f10N, INCLUDING T�-�r cos�r oF �nt�oii n�vm m�T1?RIALS: (USING THI? 1997 U.I3.0 FEG SCT1rDUL1:) OTALJnl3 VAI,UA'TION X1 � y i'S G w_ OCCUI'ANCY '1'1'1'1? ---.. ---- - -- ---- I'ermit Fee y> __ ���,o`� See 13ac1: Pa�;e for Fce Schedulc __ -- -- -- I'lan Rcvie�a .`h GS°/� of [3uilding Permit Pee Fire Surcharre .� —_----Z � 001'times the total job v�aluation Surchar<�,e 9� ----r°�,- �� 0005 x�'ermit Valuation Minimum $5.00 l.icense S�n�char��c `G ___ ��f.xJ__ R5.00 (Srale Liccnsed Rcsiilential Contractors) SAC Charge $__ _ _ $2230 per SI�C Unit (Plans to M WCC for detcnriin��tiun) ---- Curb Cut Escrow $ i� �- 6 ft = ft x'f�25� 9� — - --------- --_ __ ___ I�rosion C<mtrol 4+ __- -------.-- '�450 Conservation Plan ('.evie�a� --- Parl: Fee —`h --------- --- Fce Uetc.rmined by I:n��,inecrin'_� Se«�er Main Ch�r�e 9� �greemcnt necess�u-�� O Non Necess�ary O _._----- I�cital Due X ��' 3_�_— Malce checl:s Payable I��: City of f�ridle},� -___Atl:+ch Sli�iulalions — --- ---.. ----- -- -- riiis is nN ni>ri_icnrioN roR n i�rr.n�rr-NOT v,ai..n� ��Nri�, rr<�ci:ssei� I herebv s�pply fi�r a hnildin�, ��ermil �uid I acknrn��led�e that the inforination above is complcle and accurnle; lhal lhe �vorl< ���ill hc. in conformance ���iih tlie ordinances and c�des c�f the '" y of Fridley anei �vith the Minnesota �tmsU-ue.tion Codcs; tliat I uneiersl��nd this is not a pennit hut c�nly �in a��pliealiein i�x a ��ern ancl w rl is not to s[arl ���ilhenit a permit c�n site; �hat the ���orl: �-vill be in aeecx�lrinee with th� ;Ip��rov�d ��lan in the case c� �ill wo�l: ���I icl� �e ir .• r.vie�v and approval of plans. �1 til(INA'flll:l c)1 AI'I'I..I('AN'I' -----��-� —_ .- I'IZIN'f IJn�41=.—�� —S_��/ n_�_ _-----I �n'I I:. Y�j � � I -- �I'PROVAI_ WS�'I:C'1'Oft tiIC I�UItG P1.l:ASI:NO'T'F�:�SFT'�1TZ/�7'1: VI�RN�TS /j�jZl:l�L-;l�'Ullt}�D FOR.PLUME3INC,_ ['L.I.:C'1'IZICALANI) Ml�:ciinrvi�:ni� WOI:K