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P - 48482
Building BUILDING Permit No.: � .I���tions RESIDENTIAL APPLICATION Received By: � 7�3_572�3g�� CITY OF FRIDLEY vate xec'ct� 763-502-4977 FAX Er�cTTVE r-i-zoii DATE 2. '�%� i� YOUR E-MAIL ADDRESS �eb � m �r �w�o� li fi � SE1 c� ��j1 j� C c, M si� aDDxESS 1`i 25 � ca C's �ICr � 4 THIS APPLICANT IS: ❑ OWNER �CONTRACTOR PROPERTY OWNER/ NpME: �en � �y�;, TENANT aDD�ss: ��i2� (2 � ce. C:t�*•-12. � crTY C1 STATE V1I ZIP .SsS�f 2 Pxo�: '�63'S?j-�'6Yf' CONTRACTOR N�: �V� ��.�,� �� SUBMTT A COPY OF STATE LICENSE #� dS 6S LEAD CERT NUMBER 1" j�3�5—i C� - C� � ff ?/ YOUR STATE LICENSE �- AND CERTIFICATE OF ADDRESS: S�7 � C 6�e.e.�v3' /4,i-e. CITY d"�,q ta STATE � ZIIS s3 0 1 INSURANCE PHONE �.� • Z 7.4 -�542`? FAX 713 �- `7�2d- W c,Z,v PROPERTY TYPE SINGLE FANIII.,YlNEW CONSTRUCTION SIZE ❑ TWO Ff1MII,YJNEW CONSTRUCTION STORIES PERMIT TYPE ��DITION ❑ GARAGEJSHED ❑ WINDOWS ❑ BASEMENT FITtISH ❑ ROOF ❑ DRAIN TILE ❑ DECK � SIDING �I OTHER ❑ SWIMIvvIlI1G POOL � � TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION 'MAINTENANCEIItEPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: �4�r cip,'v�t �{, CY,�c � SIZE OF IMI'ROVEMENT � LENGTH WIDTH HIIGHT FT ROOFING ❑ HOUSE ONLY BASE.MEEI�IT REMODELING SUBMIT: NUMBIIZ OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSID SIZE: ❑ DETACHED GARAGE 3. List of structtual members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS_ & PORCHES SUBMIT: ❑ Vinyl ❑Soffit 1. Site Plan/Survey showing the existing sUVCtures ❑ Alutninum ❑ Trim and proposed project. ❑ Other ❑ Fascia 2. Two sets of construction plans WINDOWS 3. Energy Cxlciil�tions IN EXISTING OPEI�iINGS ❑Yes �No LOCATION OF WINUOWS FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANiJFACTI7RE STICKER ON WINDOW. OPINING CHANGES & TYPE OF WINDOW TO BE 1NSTALLED NLJMBER OF WINDOWS a1,1, r���� aK� BA��:D UlV VALUA�1�lUlV, llYC:LUDiNG THE (:OST OF LABOR AND MATERIALS: TOTAL JOB VALUATION $�i�S,i�i � aTH ��9�7 U.B.0 FEE SCHEDUCL�)�CY TYPE ) Permit Fee Plan Review Fire Swcharge Surcharge License Surcharge SAC Charge Curb Cut Bscrotiv Erosion Control Park Fee Sewer Main Charge Total Due $ $ $ $ $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $5.00 $5.00 (State Licensed Residential Contractors) $2230 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$24=$ $450 Conservatian Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make c6ecl�s pavable to: City of Fridlev Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an appl' ion fo • ermit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case k wlu re'� es review and approval of p ,(�� �� SIGNATURE OF APPLICAN'I' �v PRINT' Nf11vIE �� pUr'J' \ DATE Z-�s " f� APPROVAL INSPECTOR SIGNATURE PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBiNG. 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