P - 48675Building
fnspections
r63-572-36oa
)ATE � T'�P tti
;i'TE ADDRESS �y
['[�lL4 APPLICAMT 1S:
BUILDING
RESIDENTIAL APPLICATICIN
O OWNER
CITY OF FRIDL�Y
YO11R E-MAIL ADDRESS
. iv _
ipG'QNTRACTOR
Permit No.:
Received By:
Da�t,e Rec' d:
e.K.� �-u.�� � + .0 k - N
. .
PROPERTY OW1�iER1 NpNtE: T�
TENANT ADDItFSS: ''� CITY STATE ZIP
PH4NE:�0�"''J�'O�- 93 3N
- --- ----- n'-- w � a �..,.....
CUIV'f�ltAl:l V[c NAM$:
5UBMIT A CQP'Y OF STATE LIC£NSE i!
YOUR STA'TE LiCENSE ���SS:
wrrK A�LicA�oN p,�or�
PROPERTY TYPE
PERINIT
TYPE OF
1920 County Road "C° West
Roseville, MN 55113
License #BC7.30983
b51-2b4-4777
O SASEMEIVT FINISH �1 AOOF
O DECK D SiDIN4
n
BTATE ZIP
❑ ��N n�.�
n o�cE�.
DESCRIBE WORK BEING DONE: �o �a ce � •,r�. ..�s c.zS?: n�, �; �-��n � nc�
. ..._......., rvrm^ta _ 1-�F.iC�HT $q. Ft.
OF SQUARES
C,r,�. IRAGES
PROPOSBD 51ZE:
PROPOSEb HEIGH'[':
�
O Vinyl
p Aluminum
O O�her
❑ HOUSE � Q�ARAGE
� ATTACHED GARAGE
D DETACHED GARAGE
OSoffit
D Trim
O Faxia
(1.�� OPEIIIN(i3 DYes ONo 40CATi0t� OF WINWWS
O[t FOR NiEW OPENIWC3S-DESCitlBE SiZE OF
OP'ENING CHAt3GES dc _„ ,,,, „z .
����,�cu�r Q�l�!nnm.lNC3 SCffiB�1?•
l, Existiug FloorPlan
2. Peopoeed Boor pian
3. List of slntcEUis1 m�tiberc to bc wvd
pQR NEVY COTLSCRUCTION INCLUDING DECKS,
nnnt�clDNS & �RrHES a4raMtT:
1. 3i�e PkinlSurvey sbowin8 tYe existing stnc
sad praposed p�oject.
2, 7Ww sets of consuuction pf+uss
3. Enagy Glculetions
= wiNUC..�w iv nc,r� �..,..Lt...,
pl,i, FEES ARE BASED Ul�f VALUATION, INCLUDING THE COST UF LABQR AND MATE •
(iJS[NG THE 199'7 U.B`C FEE SCHEDULE)„
_ .� �. .. �n��oc+
r.�
Permit Fee
Plat� Review
Fire Surcharge
Sw�chargc
License Surchm'$e
SAC Charga
Curb Cut Escrow
Erosion Control
Park Fce
Sc�wec Main Charge
v,
� � ti�, �..�j~' See Back Page far Fee 5chedule
� � 65% of Building Permit �ce
� p .QOI times the total job valuation
$ Z.. .0005 x Permit Valuation IVlinimum 5-50
� S.� $S.dO {State Licensed Residentiat Contrar,tors)
$ $1SS0 per SAC Uxrit {Plans to MWCC for detamicration)
� ft+bft= ttx$21 �$
$ $450 Conservation PSan Review
$ Fe� Determined by EnginecrinS
� Agresment na�ssary ( ) Non Neoessary ( )
a i rf 2 I_I� Meic� wLeu!1tc nav9�f�! ti[►: C�LV DiF17dEE]' A�31
TI-I1S 13 Al+f APPLICATIQN FOR A PERMIT-NOT VALID UNTiL PROCESSED
I hereby apply for a building permit and i adawwledgo that the information above is coroplete and ac��ate; thst the work will 1
confamnanoe with the ardinanees and codes of the City of Fridley snd with the Mirmesota Construction Codes; that I�mder9taed this is
perrnit but only an applica#ian for a pelmit and wrnk is not to sta�t without a permir, that the warlc will ba it► socordance with the apPi
plan m the case of all wock whi 1S r+e�uires iew and app�ovai of plans. Z
SiGNA,TURE OF APPLiCANT _� ' �.��.�CL�PRINI' NAME�{(,�,� �-�I1�C� Y�..`� DATE �i �
� . _I .-..-. iu� i �n�nn•�i �� n�in�i�.^n�n� � �� •�fin �i " nni n��n� nn •n�ni � � � ' � � -. � .-.� .+� . _I..