P - 46937N4V-02-2011 01:24
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Insp�ctions
7b3-�'72-36Q4
763-�02�4977 FAX
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S1TE AJibRESS �
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`I'�NANT
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YQC7it.. STqTE LICENSE
AND �RTIFICATE OF
1t�iSiIRAIVCH
PR 1 �RTY TYPE
PM STAMDARD WATER CONTRdL 763 S3� 1882 P.03
,� <111,��IN(i Permit No.:�6 � (��s��
R�SID�+ N�'IAL AFPLICATI(�N �t.ec�ived �y:
C�'TY �� FRY,DLE�Y D�t��t: � � , � b � ��
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❑ OWN�i �CONI"RAC3'QR
ADDRF.SS: � �..�'�„_ � C1TY STATE ZIP
PHONE: �(�,3�[�(=_���,�"Z.._
2d'AM�;
STA'i'E
PH4N�, . ./ [0 � ^ ,� -'S % � � 8 `��
0 SINGL,B �AMII,Y/NEW CON5TRUCTION
(] TWO FAMiLYR+f1W CONSTRUCTION
Q BASEMENT FINYS�T O RCx7F
❑ DF.CIC 0 SIDYN'(`r
'Y"Y�� QF WQiiK: D IVE'Cl� H01� CONSTRUG'fIDN' O ADDITTON
O i�A�VT�IANCE'JREPAIR O ABMQDELINt3
DERCRI'�3E WdWt BEING 1�1�; �
SIZE UF.iM�'RQvL�MENT LENC3'i'H WID7i�i
O HOUSF. ONLY
NUMB OF BQUARBS �_,�___ a xaUSE ��n�n�;a
P1Z� S17F.:
PRO�a�Bn r��c�rr: ..
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C Vinyt
O Alusdfnum
O Qlher.
IN���G OPENINC35 oYee �No
OR FOi� NEW QPENINGS-DE5CRIB� SIZL� OF
C1PEbTRiE1 CHANCxFS dC
FEEB AhE BABED ON
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Flan R�vievu
�'ire Surchargo
Setrch�
LiCens� StuCharga
SAC C$�rge
Cutb CWt Escror�v
Erosioti Can�o1
Psrk F��
Sewer 1VCa'sn Charge
Cl ATTACHEIS (`:ARAGE
❑ DETACFi� �iARR4E
CERT
,aT�����
�nRAIN TILE
0 UTH�R
�..as�-rrr �an�,r.nuG q���vm�r:
1, Exlsltng Ploor Plsn
a, Proposee n�or plaa
3, Llst of struct�usl mpnbors to be uacci
FOA'1�W CONSTRUGTION' IlMTCLUDINCr DECiCS,
oSomt �r�nyrrdxs. a� YaR��ES � ��T�
1, Site Planl$WVCy sh4wing the pci�[ing sKUCturee
�1 T�im
O FaseiR end ptopoaed projeCt,
2, Trwo sets of construction pinna
3, Enelgy Ce1Cul�ti0ns
LDCATION OF wIIVI�4W3 �OR WINDUWS — PROVTDE U•VALUE AND
MAN'UFACI'URE STTCKF�t ON WIN[�OW.
NL1]vffi8R OF W[NDOWS
�.uATTON, �iCLUDYNG THE COST O� LaBOR ,AND ri�a�RULS:
SING T� ig�r U.B.0 �E� SCH��ULE)
$ j:� 5al S See Back P�ge for Fee 5chedule
$ 65% pf $uilding Fermit Fce
� V A4l times the total job valuation
� '�� .0405 x Perntit V�luation Minimum Ss.00
� $3.00 (5tate Licensad Rtsidential Contrsctors)
$ $223U per SA� Unit (Fl�ns w MWCC for determination)
� �}�+6ft= fitxS23=S
� S45Q Conservatian Flaa Revie�
$ �'ee �etermined by Engineering
� Agreemant necessary ( ) �Qn Necessary { )
S 1. � Makc checl�a navabie to: Citv oi �'ridley Att�c
TH1313 AN APPLICATI(7N FUR A PERMIT•NO"f VAI,1p ITNTiL PROCB$S�iD
i here�iy appl� for a building permit and I aoknowledge chat the information above is complete and accurate; thst the work witl be in
confortnanoe with the ordinances and codes of tlte City of Fridloy snd with the Minnasata Cons�uction Codes; that I underata�d this is not a
pemait but anly an application for � permit and work ie not to start without a permit oA site; that the worlc will be in accord�nce �uvith the
appmv�d plan in the c�se af +w� � ires review attd approval of s. �/� ��
SIGNAI'CAtE OP APPLICANT !��� PRFNT NAME�� � 1�.i1 �" DA'I'£,
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