P - 60283Building
Inspections
763-572-3604
763-502-49�7 FA�X
SITE ADDRGSS ��
THIS APPLICANT 15;
TEiVANT
C4NTRACTOR
SUBMIT A COPY Of
YOUR STATG LICCNSE
AND CERTlf'1CATG OF
INSURANCG
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�ESIDEIVTYA�L APPLYCATY�PJ
CITX OF' k'�.�a]�EY
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YOUR GMAII, ADDRESS
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TYP� �SINGLG FAMILY/N�W CONSTRUCTION
O'i'w0 f�AM14Y/NFW CON977iUC'I'I(!N
YPE Q Auuri7UN p c;nxAC;
O BASEM�N7' b'lNISH �ROOC
O DCCK 0 5[D1NG
CERT
SIZE
3'I'OItIEiS
1'YI�� QF WQRK; 0 NBW 410Mfi CONSTRUCTION 0 ADDiT[ON
�'MP,jN'1'�,NANCC/RL':PAIR � RL"MODL•'LINC
L7L3SCIt�DC WORK DEING DONG: � '�i C�i!Z I''+C. I�'L
SI/�S t?� iMPRAVI4M�NT i.CNC7'i•t WIDTH
RObFING O 1•tOUSIi ONLY
NUMB�R Qf SQUARES r i ❑ I•IOLISC & GARAGC
�Q@�'� CI ATTACI•IGD GARAG�
I'ROPOSED SI'/.fi; O DI�PACI1�l7 GAR�GE:
PROP05ED HE{GHT:
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0 07�i�tt
p���t
Received By: '
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jj�SL�,� MENT REMODELING SUfiW11T:
I, fixisling Floor Plnn
2, Propo:accl Iloor plao
3. Li� of structurn] mnmben to bc used
��� rOR NI?W CqNS7'RUC'flON iNCLUDiNG DGCKS,
0 Vinyl OSnflil SIDING/SOI'G'ITICASCIA LL1Z[TIONS. �t ['dftCHES SU�MI'�':
E] Aluminum [7 7'rim 12�,MOV�U? L� YES C] NO I, Si�c f�1�MSurvoy vhowing thpcxivting xtructurcs
� Oth�r � Fascia und pro�d project,
2, Twa �ct� of conxtruclion pluns
�v,s, nbWti 3, �ncrgy Calculution.�
IN EX1S'1'ING OPCNINGS DYer. �No LOCATtON Of WINDOWS POR WINDOWS -- PROViDE U-VAI,Uis AND
OIZ FOR NI:W QPENINGS-u1:SCttlklls St"LL' OF MANUFACTUR& STICKER ON WINDOW,
p�kN1NG CHANGr;S �
TYPS OF WINDOW TO DE 1NSTALLGD NUM�GR OP WINDOWS
ALL ��ES AR� �AS�� ON VA�.UATION, �NC1.L1UIIVG THE COST QF LABQR AND MATERlAL5:
'OTAL JOS VALUATION S!�j ,��J�� �� r997 U.�i.0 FCC SCI�t �CCUPANCY TXPC
ACrmit Fcc
Pl�n Rcvicw
Firo Su�Chargc
Surchargc
Licensc S�rcharge
SAC Chargt
Curb Cut Escrow
Crosion Control
Purk ree
3ewer Main ChArge
._$_____ �%,��_____ See Back Page for Fee Schedule
$ GS°k pf Building Ptrmit Fee
__..__ _
$ ,001 timas the total job valuntion
$ .0005 x I�cratiit Valuation Minimum ar .50
$ $5.00 (State Licensed Residenti�l Contractors)
$ $2365 per SAC Unit (P��ns to MWCC for determin�tion)
$ tt+6 R� ftx$25 =$
$ $450 Conservntion Plan Review
� Fee Determined by Engineering
S Agreement necessnry O Non Neceasnry (}
$ Makc cbocks nnvnblc ta: Cilv of Fridlev Attncl
9'FifS 15 AN APPLICATION FUR A PEKMi'�-NU'I' VA1.I1� 11N'�'141'KUCESSL'D
1 hcrcby apply fOr a hu�lding permit and 1�ckno cdgc that thc infprm�tipn aboYC i5 oumplqta flnd accurAte; that the work will be in
conformance with the ordinan es nnd oodes of the ' af Fridley nnd with the Minnesou► Construction Codes; th�t [ undCrstand this is not A
pormit but only �n apqlic io fo � �k an is not to start without a permit on sitc; th�t the work will be in accordflnce with the
Qpproved plan in the cf�se f al v' d nppravnl of ns. Q� r
SIGNATUR� OP APPLICAN RiNT NAMC�:�iX�1�C� C� 8��' DA'PG ��`�� 1 __ _
APPROVAI. INSP(:CT()R SIC; I't1RE
7/I ..I AIICF�-7A�. �COII Ei C71 A.111Q�IIIl1Ll �lsl _�I rCf1.1+A_71f17
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