P - 449243uilding
ns�ections
%63-572-3604
.4TE�
iTE ADDRESS
HIS APPLICANT IS:
�!
'ROt ERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YpTJR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMTT TYPE
BUILDIi�TG
RESIDENTIAL APPLICATI4N
CITY OF` FRIDLEY
YOUR E-MA
n 9 � � C�pr �
❑ OWNER '1QICONTRACTOR
P �`
ADDRESS: (i �� � i�L � f'1 ! l� %� �
PHONE:_ � L 3 I � 7 I• S? 4 8
Pella Windows & Doors
N'�'—' 15300- 25th Avenue N.- Suite 100
STATE LIC P1j�TT10Ui�'1, MN 55447
.aDDt�ss: �63/ 745-1400
PHONE License# 20165884
'67 SINGLE
❑ TWO FA �
� dt"s ca Q
CITY � /'r cl ( c
o�
CITY_
'E
.ORIES
QADDITION ❑ GARAGE/SHED 19�WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRA1N TILE
❑ DECK ❑ SIDING ❑ OTF�R
❑ SWIMMING POOL
TYPE OF WORK: �
_ _ '6
-ESCRIBE WORK BEING DONE:
IZE OF IMPROVEMENT
UMBER OF SQUARES _
ARAGES
tOPOSED SIZE:
ZOPOSED HEIGHT:
O REMODELING
t�r �` 1.� 4 !,�
LENGTH
❑ HOUSE ONLY
❑ HOUSE 8c GAR.AGE
❑ ATI'ACHED GARAGE
❑ DETACHED GARAGE
:DIlVG
Vinyl ❑Soffit
Aluminum ❑ Trim
Other ❑ Fascia
INDOWS
� EXISTING OPENINGS iaYes ONo LO TIO OF WINDOWS
2 FOR NEW OP�TtINGS-DESCRIBE SIZE OF �Q4 �r • J. Sp 0�-�, Stw iA4 - �• D��i/,� y
?ENING CHANGES &
�'PE OF WINDOW TO BE INSTALLED ��� NUMBER OF WINDOWS �
ALL FEES ARE
. TOTAL
;mut Fee
an Review
ircharge
re Surcharge
cense Surcharge
�C Charge
u-b Cut Escrow
�osion Control
�rk Fee
:wer Main Charge
�tal Due
Permit No.
Received Bv:
��
.-� -
STATE ZIP 5� � �
�/345 • G o+� 7
Jo n ,t 5
STATE ZIP.
r!1 � 0
Ft.
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. Bc PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
3A5ED ON VALUATION, INCLUDJNG THE COST OF LABOR AND MATERIALS:
([TSING THE 1997 U.B.0 FEE SCHEDULE)
VALUATION $ � a, 3p O OCCUPANCY TYPE
$ / 9 S•.? S See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ 5- ! (.0005) times the total job valuation — Minimum $.50
$ ! o. � d .001 x Permit Valuation (1/10%)
$ $ ; b � $5.00 (Staxe Licensed Residential Contractors)
$ $1450 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$20=$
$ $450 Conservation Plan Review
$ Fee Detez-mined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ 07 /'1✓ . 7 O Make checks payable to: City of Frid� _ Attach
THIS IS AN APPLICATION FOR A PERMTT-NOT VALID iJNTIL PROCESSED
�ereby apply for a building permit and I aclrnowledDe that the information above is complete and accurate; that the work will be in
nfornnance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
rmit but onIy an application for a permit and w rk is not to start without a permit; that the work will be in accordance with the approved
�n in the case of all work which re u' es rev'ew approval of plans. p �/ �j
''� �!/ l r l� � l/L /�I � DATE r l a C l J
1NATURE OF APPLICAN PRINT NAME