P - 40728Bu�lding
Inspccti�ns
7G3-572w3f04 •
763-502-4977 k'A�
Frorn: unknown Page: 2/2 Date: 9/19/2011 1:11:47 PM
. BUIL�l�NG
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CONTRAC'TOR Nast�:
s�rsn�nT a copY o� gTATE LIG'ENSf
YUUK ��FA'1� L1V�TVS�.
AND CERTIFICATE OF AribRES3:�
INSLTFZANCE rna.,�rc •%l %�.-'.
CITY UF F�t.IDLEY
YO[J�t �•M�iT. ADTIRESS
LJ Tw0 �'AM:iZ,XrNEw GUNS'['�tUC'f.ION
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DESCRIHE WCSitI: $ELVG DO�: O� a; Y+
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i
� HdLTSE ONZY
NL�HR pF SQUA�RES � B'F�QU3E dc GARAGE
r_a�. Rm ���� � ACFiEbGARAGE
�ROPC75EU SIZE: • e":� TAt�D GARA4�
PRt7POSEt7 F�tGHT:
$IDING
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IN E3CQSTiNG OPEN7NG5 OYea C1No
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OPENiI3G CEiANG�S �
i�� Revi�r
Firc S�charge
Svrchm�gc
Licen�e SutGl]atge
SA[: Cb�rgc
Cu� �t Escrow
Erasion Contro�
Park Fee
Sewer Main. Char�e
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� Tawia
LdCA'IION OF �ViNDdWS
arr vaLUa��to�', �rrcLVpnv� � cosr o�
'�.a(U�SD!tG'�iE 1997u�.c FEE sc��uLE)
a w,a�ows
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Q O'�A
Pernc�it
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BASh'�VfENTRP pR�L�G.SU8MI1':
t Rriatin$F7r,rx�Plan
Z. Proposod $oor plaa
3. L�at of s6uctaaai membcie ta be m�od
�.
FURNE'W CI�N�TItUl:T1UN 1Ni.:LUUtN<i,l]kC:�,
nnnrizaxs. � poRC�c ��.
x. 5iRe �au/Sw�rey ahnwamg khe a�ta►g abveturea
and pmpoved pmjae�
�. �VO 9CG� Of COIil1TIYEt1rtM �lny
3. �ergy Calculatiau
�G1R WINDOWS —pROVmE T7 VALUE AND
�unrr�,�n.c'IVxs s'rlc�t c�r� w�rmow.
soR arm
r� �:;�:5 ^ s� ��x pag� foT F�� s�nGa�a� �
6S% of �uilding Permit Fee
� 001 �imas the tota� job vaiuedon
.0003 x,�e�7�it Vaitlsuon lvl�iaxkUm Y,�.W
"E �. ,'% $5.00 {State Lic�nscd Residential Cornractors)
$2230 pex SAC Uilit (Plans to MWGG for deter�tion)
,� ft + 6 ft =--- ft x$25= �
__ . � $450 Conse�vatiaa Plan R�wiew
. Fee l'�etcrmiued by �ineerin�
,,,,�..�� A�einer�t m�}' () Nau Necessary ( j
Ti3I3 IS AId A�ppjdCATiON F4R A FE�RI�IT•NdT VALii7 UN'J'l4 [�K(K'ES5ED
I l�eret�y apply far a building perm�t and I aclazowledge kt�a# the it�ormahon above is aompiete and accu�raUe; t]�st the waz'� will be in
con€orma�ce with the undinanees and cades o e City o ridiey and wi#h thc Mi�esota Con�uvetion Codes; t�ctt'I understand this i.s uot a
persrut l,ut �Lly ara dp�uc,txtion tbr a�enn3t asid o11c i�' o[ [o sisrt without a peim�t on site; tirat tbe wc>rk wiil tie in ac�ecMda�C� With the
appzaved �lsa in the case o work ' e zew atxd a prwal of p R.
SIGNATtTRE OF t1PPLfCANT ' �� � ^��A.� 4 �f� (r
�RG�rAi. INSPfiCTt3tZ SIG 'A F.